Healthcare Provider Details

I. General information

NPI: 1295358026
Provider Name (Legal Business Name): AUSTIN WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 LOVERIDGE RD
PITTSBURG CA
94565-5117
US

IV. Provider business mailing address

688 OLD QUARRY RD APT 10
PLEASANT HILL CA
94523-1426
US

V. Phone/Fax

Practice location:
  • Phone: 888-678-7277
  • Fax:
Mailing address:
  • Phone: 510-207-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT117619
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: