Provider Demographics
NPI:1437696168
Name:WELLS, ANNA MARISSA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARISSA
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WILSON FARM RD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-8200
Mailing Address - Country:US
Mailing Address - Phone:501-557-6785
Mailing Address - Fax:501-613-0411
Practice Address - Street 1:8 WILSON FARM RD STE D
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-8200
Practice Address - Country:US
Practice Address - Phone:501-557-6785
Practice Address - Fax:501-613-0411
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1811145101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional