MEDICARE: JOAN WELLS GILL LPC

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	19866	TX

General Provider Information

NPI Number	:	1396925673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN WELLS GILL LPC

Provider Business Mailing Address
First Line	:	9608 DOLIVER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1013
Country	:	US
Telephone Number	:	713-789-8645
Fax Number	:	713-789-9130

Provider Business Practice Location Address
First Line	:	4200 WESTHEIMER RD
Second Line	:	SUITE 201
City	:	HOUSTON
State	:	TX
Zip	:	77027-4415
Country	:	US
Telephone Number	:	713-906-0307
Fax Number	:	713-789-9130

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

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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