Healthcare Provider Details

I. General information

NPI: 1740887363
Provider Name (Legal Business Name): CORINN ELISA WELLS B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINN LIPPERT B.A.

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 COLE ST # 368
SAN FRANCISCO CA
94117-4316
US

IV. Provider business mailing address

912 COLE ST # 368
SAN FRANCISCO CA
94117-4316
US

V. Phone/Fax

Practice location:
  • Phone: 415-275-0092
  • Fax: 415-349-0050
Mailing address:
  • Phone: 415-275-0092
  • Fax: 415-349-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number94029723
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: