Healthcare Provider Details

I. General information

NPI: 1821966029
Provider Name (Legal Business Name): ANN WELLS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 D ST
IDAHO FALLS ID
83402-3531
US

IV. Provider business mailing address

452 D ST
IDAHO FALLS ID
83402-3531
US

V. Phone/Fax

Practice location:
  • Phone: 208-552-0355
  • Fax: 208-552-3201
Mailing address:
  • Phone: 208-552-0355
  • Fax: 208-552-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: