Healthcare Provider Details

I. General information

NPI: 1558126722
Provider Name (Legal Business Name): ANDREA MARIE WELLS MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5751 TERRA BELLA CT
CAMARILLO CA
93012-8817
US

IV. Provider business mailing address

5751 TERRA BELLA CT
CAMARILLO CA
93012-8817
US

V. Phone/Fax

Practice location:
  • Phone: 210-347-6716
  • Fax:
Mailing address:
  • Phone: 210-347-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: