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General NPI Number Information
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NPI Number | 1649930645
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Entity Type | Individual
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Provider Name | TAIJUANA WELLS MA., LPC
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Gender | Female
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Dates
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Enumeration Date | 12/19/2021
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 737 DUNN RD
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City | HAZELWOOD
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State | MO
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Zip | 63042-1740
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Country | US
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Telephone | 314-230-0362
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Fax | 314-731-4433
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Provider Business Mailing Address
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Address Line | 1501 MOONLIGHT DR
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City | SAINT LOUIS
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State | MO
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Zip | 63135-1448
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Country | US
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Telephone | 314-338-1896
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2021042219
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License Number State | MO
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