Provider Demographics
NPI:1083143705
Name:WELLS, SIE'YARA JEMISCOE
Entity Type:Individual
Prefix:
First Name:SIE'YARA
Middle Name:JEMISCOE
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N MARTIN L KING BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7675
Mailing Address - Country:US
Mailing Address - Phone:702-684-7757
Mailing Address - Fax:
Practice Address - Street 1:3925 N MARTIN L KING BLVD STE 207
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7675
Practice Address - Country:US
Practice Address - Phone:702-684-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty