Healthcare Provider Details

I. General information

NPI: 1760852107
Provider Name (Legal Business Name): LASHANDRA WELLS M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LAKE ST
LAKE PROVIDENCE LA
71254-5208
US

IV. Provider business mailing address

1700 LAKE ST
LAKE PROVIDENCE LA
71254-5208
US

V. Phone/Fax

Practice location:
  • Phone: 318-559-0414
  • Fax:
Mailing address:
  • Phone: 318-559-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3470
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9722
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: