MEDICARE: WELLS COUNSELING SERVICES LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639966237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLS COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	47080 HIDDEN RIVER CIR N
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47080 HIDDEN RIVER CIR N
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6313
Country	:	US
Telephone Number	:	734-331-0463
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNETTE WELLS
Credential	:
Telephone Number	:	734-331-0463

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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