MEDICARE: LAKESHIA WELLS MS, BCBA, LBA

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	4937	TX

General Provider Information

NPI Number	:	1154862712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKESHIA WELLS MS, BCBA, LBA

Provider Business Mailing Address
First Line	:	2368A RICE BLVD # 108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10830 CRAIGHEAD DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5804
Country	:	US
Telephone Number	:	713-730-9335
Fax Number	:

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

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/31/2022

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