Provider Demographics
NPI:1588389928
Name:WELCH, EMMA (PHD)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:EVANOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26515 STATE HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:SHELL KNOB
Mailing Address - State:MO
Mailing Address - Zip Code:65747-7951
Mailing Address - Country:US
Mailing Address - Phone:563-320-3483
Mailing Address - Fax:
Practice Address - Street 1:26515 STATE HIGHWAY 39
Practice Address - Street 2:
Practice Address - City:SHELL KNOB
Practice Address - State:MO
Practice Address - Zip Code:65747-7951
Practice Address - Country:US
Practice Address - Phone:563-320-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022025343103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist