Provider Demographics
NPI:1730385733
Name:WELSH, DAVID J (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:WELSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 CAMP BOWIE BLVD
Mailing Address - Street 2:SUITE 52
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5612
Mailing Address - Country:US
Mailing Address - Phone:817-735-8299
Mailing Address - Fax:
Practice Address - Street 1:6040 CAMP BOWIE BLVD
Practice Address - Street 2:SUITE 52
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5612
Practice Address - Country:US
Practice Address - Phone:817-735-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23191103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist