Provider Demographics
NPI:1528364320
Name:WELCH, KAREN S (MFT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:S
Last Name:WELCH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17332 IRVINE BLVD
Mailing Address - Street 2:SUITE #232
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3036
Mailing Address - Country:US
Mailing Address - Phone:714-470-3087
Mailing Address - Fax:
Practice Address - Street 1:17332 IRVINE BLVD
Practice Address - Street 2:SUITE #232
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3036
Practice Address - Country:US
Practice Address - Phone:714-470-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist