=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699436519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE WELLS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2022
-----------------------------------------------------
Last Update Date | 05/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 SKYLAR CT
-----------------------------------------------------
City | SHAMONG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08088-9611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-279-0020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 SPRUCE ST
-----------------------------------------------------
City | DEERFIELD TWP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08302-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-792-1912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 37AC00504300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 37PC00951100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------