Provider Demographics
NPI:1457882219
Name:WELCH, CYNTHIA (LCSW-S)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SANDRA PALMER ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-5925
Mailing Address - Country:US
Mailing Address - Phone:682-429-5335
Mailing Address - Fax:
Practice Address - Street 1:302 MORGAN MILL RD STE A
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3617
Practice Address - Country:US
Practice Address - Phone:254-233-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375297403Medicaid