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General NPI Number Information
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NPI Number | 1982119111
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Entity Type | Individual
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Provider Name | JEREMY WELLS LPC
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Gender | Male
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Dates
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Enumeration Date | 12/11/2017
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 29623 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1076
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Country | US
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Telephone | 313-932-5527
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Fax |
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Provider Business Mailing Address
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Address Line | 19708 LEXINGTON
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City | REDFORD
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State | MI
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Zip | 48240-1517
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401019485
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License Number State | MI
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