Provider Demographics
NPI:1699389270
Name:WELCH, SHANNON CASEY
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:CASEY
Last Name:WELCH
Suffix:
Gender:F
Credentials:
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 1375
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1375
Mailing Address - Country:US
Mailing Address - Phone:530-270-9043
Mailing Address - Fax:
Practice Address - Street 1:194 GOLD FLAT RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3237
Practice Address - Country:US
Practice Address - Phone:530-270-9043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist