MEDICARE: DR. KRISTEN WELLS 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	0701003917	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710998455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN WELLS LPC

Provider Business Mailing Address
First Line	:	PO BOX 12031
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23241-0031
Country	:	US
Telephone Number	:	800-961-1726
Fax Number	:	804-510-0309

Provider Business Practice Location Address
First Line	:	2119 W MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4527
Country	:	US
Telephone Number	:	800-961-1726
Fax Number	:	804-510-0309

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/21/2022

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