MEDICARE: BARBARA WELLNER M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00007853

General Provider Information

NPI Number	:	1093854143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA WELLNER M.ED.

Provider Business Mailing Address
First Line	:	1017 PAPAGO DRIVE FI
Second Line	:
City	:	FOX ISLAND
State	:	WA
Zip	:	98333-9667
Country	:	US
Telephone Number	:	253-549-2070
Fax Number	:	253-549-2070

Provider Business Practice Location Address
First Line	:	1017 PAPAGO DRIVE FI
Second Line	:
City	:	FOX ISLAND
State	:	WA
Zip	:	98333-9667
Country	:	US
Telephone Number	:	253-549-2070
Fax Number	:	253-549-2070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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