Provider Demographics
NPI:1093415184
Name:WELLS, LISA (LMHC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N MERIDIAN ST STE 340
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2850
Mailing Address - Country:US
Mailing Address - Phone:317-779-1257
Mailing Address - Fax:
Practice Address - Street 1:9240 N MERIDIAN ST STE 340
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2850
Practice Address - Country:US
Practice Address - Phone:317-779-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99116661A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health