Provider Demographics
NPI:1326894866
Name:WELLS, KIERSTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W GROVE PKWY APT 1009
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4515
Mailing Address - Country:US
Mailing Address - Phone:480-695-3079
Mailing Address - Fax:
Practice Address - Street 1:1220 S ALMA SCHOOL RD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2078
Practice Address - Country:US
Practice Address - Phone:480-637-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-221821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical