Provider Demographics
NPI:1023600319
Name:WELCH, KEVIN (LCDC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10696 HADDINGTON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-3247
Mailing Address - Country:US
Mailing Address - Phone:833-364-0736
Mailing Address - Fax:
Practice Address - Street 1:10696 HADDINGTON DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-3247
Practice Address - Country:US
Practice Address - Phone:833-364-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14478101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty