Healthcare Provider Details

I. General information

NPI: 1730660853
Provider Name (Legal Business Name): EDWARD LEE WELLS LEP, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27035 WHITMAN ST
HAYWARD CA
94544-4027
US

IV. Provider business mailing address

24411 AMADOR ST
HAYWARD CA
94544-1301
US

V. Phone/Fax

Practice location:
  • Phone: 510-723-3190
  • Fax: 510-582-0964
Mailing address:
  • Phone: 510-784-2611
  • Fax: 510-784-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87423
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: