MEDICARE: WELLS THERAPY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1003622622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLS THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	711 FAIRVIEW ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 FAIRVIEW ST
Second Line	:
City	:	FOUNTAIN INN
State	:	SC
Zip	:	29644-1541
Country	:	US
Telephone Number	:	803-318-5400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DENNIS WELLS
Credential	:	LPC
Telephone Number	:	803-318-5400

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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