Healthcare Provider Details

I. General information

NPI: 1689005845
Provider Name (Legal Business Name): ROSEMARY WELLS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 09/11/2025
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4685 NAVAJO ST.
BOULDER UT
84716
US

IV. Provider business mailing address

PO BOX 1480
BOULDER UT
84716-1480
US

V. Phone/Fax

Practice location:
  • Phone: 208-815-0042
  • Fax:
Mailing address:
  • Phone: 208-815-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC6832
License Number StateID

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: