Basic Information
Provider Information
NPI: 1396017323
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELTER
FirstName: LINDSAY
MiddleName: SUE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 40
Address2:  
City: GLENWOOD SPRINGS
State: CO
PostalCode: 816020040
CountryCode: US
TelephoneNumber: 9709452241
FaxNumber: 9709455523
Practice Location
Address1: 515 28 3/4 RD
Address2:  
City: GRAND JUNCTION
State: CO
PostalCode: 815015016
CountryCode: US
TelephoneNumber: 9702416023
FaxNumber: 9702428330
Other Information
ProviderEnumerationDate: 02/07/2012
LastUpdateDate: 02/07/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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