MEDICARE: BRANDON A WELLS M.S., 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	2844-125	WI

General Provider Information

NPI Number	:	1528186517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON A WELLS M.S., LPC

Provider Business Mailing Address
First Line	:	4530 N OAKLAND AVE
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53211-1215
Country	:	US
Telephone Number	:	414-810-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 N OAKLAND AVE
Second Line	:
City	:	WHITEFISH BAY
State	:	WI
Zip	:	53211-1215
Country	:	US
Telephone Number	:	414-810-9012
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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