Provider Demographics
NPI:1215659487
Name:WELSH, LARRY JOE (LCPC, NCC, CCMHC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JOE
Last Name:WELSH
Suffix:
Gender:M
Credentials:LCPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-6401
Practice Address - Country:US
Practice Address - Phone:217-258-4042
Practice Address - Fax:217-347-7197
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014714101YM0800X
IL180.014714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health