Healthcare Provider Details

I. General information

NPI: 1982014627
Provider Name (Legal Business Name): JULIE WELLS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N LAKE PLACID AVE
EAGLE ID
83616-5960
US

IV. Provider business mailing address

1521 N LAKE PLACID AVE
EAGLE ID
83616-5960
US

V. Phone/Fax

Practice location:
  • Phone: 949-391-3505
  • Fax:
Mailing address:
  • Phone: 949-391-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number79760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: