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General NPI Number Information
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NPI Number | 1215409487
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Entity Type | Individual
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Provider Name | LAWRENCE E WELLS LPC
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Gender | Male
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 556 S ARIZONA BLVD
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City | COOLIDGE
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State | AZ
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Zip | 85128-5106
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Country | US
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Telephone | 520-723-7405
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Fax | 520-723-7410
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Provider Business Mailing Address
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Address Line | 18280 N CALACERA ST
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City | MARICOPA
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State | AZ
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Zip | 85138-3879
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17554
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License Number State | AZ
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