Provider Demographics
NPI:1265018683
Name:KATI WELLS CBT
Entity Type:Organization
Organization Name:KATI WELLS CBT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATLYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-335-6482
Mailing Address - Street 1:1116 S WALTON BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6116
Mailing Address - Country:US
Mailing Address - Phone:479-335-6482
Mailing Address - Fax:
Practice Address - Street 1:1116 S WALTON BLVD STE 116
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6116
Practice Address - Country:US
Practice Address - Phone:479-335-6482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherWE DO NOT HAVE THESE.