Healthcare Provider Details

I. General information

NPI: 1821923368
Provider Name (Legal Business Name): ISAIAH WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W LOMBARD ST
SPRINGFIELD MO
65806-2720
US

IV. Provider business mailing address

5748 S WEDGEWOOD AVE
SPRINGFIELD MO
65810-3126
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-3577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026027409
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: