Healthcare Provider Details

I. General information

NPI: 1043045842
Provider Name (Legal Business Name): ELIZABETH WELLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 S MAIN ST STE 200
AURORA CO
80016-5361
US

IV. Provider business mailing address

19762 E PIKES PEAK AVE APT 204
PARKER CO
80138-7476
US

V. Phone/Fax

Practice location:
  • Phone: 847-903-0584
  • Fax:
Mailing address:
  • Phone: 847-903-0584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WELLS
Title or Position: OWNER
Credential:
Phone: 847-903-0584