Healthcare Provider Details

I. General information

NPI: 1780546325
Provider Name (Legal Business Name): STEPHENIE WELLS CADC-R, QMHA-R, CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 11TH AVE SW
ALBANY OR
97321-2019
US

IV. Provider business mailing address

1010 11TH AVE SW
ALBANY OR
97321-2019
US

V. Phone/Fax

Practice location:
  • Phone: 541-791-7193
  • Fax:
Mailing address:
  • Phone: 541-791-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHA-R6466
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number25-CRM-4771
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-23-3309
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: