MEDICARE: DEBORAH WELLMAN M.A., L.C.P.C.

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	101Y00000X	Counselor	27	ID

General Provider Information

NPI Number	:	1770609133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH WELLMAN M.A., L.C.P.C.

Provider Business Mailing Address
First Line	:	228 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-467-5009
Fax Number	:	208-467-3945

Provider Business Practice Location Address
First Line	:	228 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-5013
Country	:	US
Telephone Number	:	208-467-5009
Fax Number	:	208-467-3945

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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