Healthcare Provider Details

I. General information

NPI: 1639727829
Provider Name (Legal Business Name): ANNETTE MARIE WELLS L.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 NORTH PIEGAN STREET
BROWNING MT
59417
US

IV. Provider business mailing address

760 HOSPITAL CIRCLE
BROWNING MT
59417
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6330
  • Fax:
Mailing address:
  • Phone: 406-338-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3423
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: