MEDICARE: MISS STEPHANIE ELLEN WELLS LCSW

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	101YM0800X	Mental Health Counselor	984C	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	984C	OTHER	AR	LCSW

General Provider Information

NPI Number	:	1184844904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE ELLEN WELLS LCSW

Provider Business Mailing Address
First Line	:	2000 MAGNOLIA AVE APT 343
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72202-1610
Country	:	US
Telephone Number	:	501-372-2970
Fax Number	:	188-846-8931

Provider Business Practice Location Address
First Line	:	225 S PULASKI ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-1925
Country	:	US
Telephone Number	:	501-372-2970
Fax Number	:	888-468-9318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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