Healthcare Provider Details

I. General information

NPI: 1255354098
Provider Name (Legal Business Name): KATHARINA WELLS LMFT, LPCC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHARINA SELLENKO

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18205 N. 51ST. AVE, SUITE 109
GLENDALE AZ
85308
US

IV. Provider business mailing address

29640 N. 132ND DRIVE
PEORIA AZ
85383
US

V. Phone/Fax

Practice location:
  • Phone: 714-345-2172
  • Fax:
Mailing address:
  • Phone: 714-345-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAZLPC19343
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC2006
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCAMFT34230
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT34230
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAZRN249135
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN330115
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAZMFT15530
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: