Provider Demographics
NPI:1376847947
Name:WELLS, JASON CHARLES (LPCC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHARLES
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10623 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8574
Mailing Address - Country:US
Mailing Address - Phone:859-462-6540
Mailing Address - Fax:
Practice Address - Street 1:252 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2029
Practice Address - Country:US
Practice Address - Phone:859-462-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional