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NPI Code Detail

MEDICARE: ALISHA WELLS LCSW

MEDICARE: ALISHA WELLS LCSW
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
1101YM0800XMental Health Counselor
21041C0700XClinical Social WorkerL11987OR

General Provider Information

NPI Number : 1811531577
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISHA WELLS LCSW
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number :
Provider Business Practice Location Address
First Line : 5100 S MACADAM AVE STE 350
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3877
Country : US
Telephone Number : 503-231-7854
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2019
Last Update Date : 06/01/2026

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