Provider Demographics
NPI:1407483308
Name:WELLS, KATHERINE JULIA (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JULIA
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3929
Mailing Address - Country:US
Mailing Address - Phone:707-433-3351
Mailing Address - Fax:
Practice Address - Street 1:411 EAST ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3929
Practice Address - Country:US
Practice Address - Phone:707-433-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional