Provider Demographics
NPI:1861869620
Name:WELCH, CHAD THOMAS
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:THOMAS
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHAD
Other - Middle Name:THOMAS
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4254 BASSEN DR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-7910
Mailing Address - Country:US
Mailing Address - Phone:618-558-0671
Mailing Address - Fax:
Practice Address - Street 1:4509 N ILLINOIS ST STE 5
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1524
Practice Address - Country:US
Practice Address - Phone:314-884-1947
Practice Address - Fax:314-408-2355
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011128101YP2500X
IL180010931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional