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General NPI Number Information
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NPI Number | 1003001504
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Entity Type | Individual
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Provider Name | SHIRLEY ANN WELLS M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 09/08/2007
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 3309 S. KINGSHIGHWAY BLVD FAMILY RESOURCE CENTER
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City | SAINT LOUIS
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State | MO
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Zip | 63139
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Country | US
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Telephone | 314-534-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 7511 WARWICK DR
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City | SAINT LOUIS
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State | MO
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Zip | 63121-2436
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Country | US
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Telephone | 314-382-7997
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Fax | 314-382-7997
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2002013515
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License Number State | MO
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