Healthcare Provider Details

I. General information

NPI: 1437354149
Provider Name (Legal Business Name): MRS. CHANDRA MARIE WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E 35TH ST
HOUSTON TX
77022-6413
US

IV. Provider business mailing address

18811 ORIOLE POINT CT
CYPRESS TX
77429-8353
US

V. Phone/Fax

Practice location:
  • Phone: 713-859-5803
  • Fax: 832-203-5274
Mailing address:
  • Phone: 713-859-5803
  • Fax: 281-445-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number001007876
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: