Provider Demographics
NPI:1003513490
Name:WELCH-URICH, SHAYLE
Entity type:Individual
Prefix:
First Name:SHAYLE
Middle Name:
Last Name:WELCH-URICH
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 1:2121 S GREEN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3318
Mailing Address - Country:US
Mailing Address - Phone:833-624-6385
Mailing Address - Fax:
Practice Address - Street 1:2121 S GREEN RD STE 203
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3318
Practice Address - Country:US
Practice Address - Phone:833-624-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-63811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-63811OtherBEHAVIOR ANALYST CERTIFICATION BOARD