Healthcare Provider Details

I. General information

NPI: 1437829025
Provider Name (Legal Business Name): MARY WELLS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 FRANKLIN BLVD
LEMOORE CA
93246-4700
US

IV. Provider business mailing address

1078 N WILLIAMS ST
HANFORD CA
93230-3525
US

V. Phone/Fax

Practice location:
  • Phone: 559-998-4474
  • Fax:
Mailing address:
  • Phone: 559-794-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: