Provider Demographics
NPI:1447599188
Name:WELLS, CHERYL MAE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:MAE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2717 N STEVES BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3959
Mailing Address - Country:US
Mailing Address - Phone:928-526-2968
Mailing Address - Fax:928-526-0708
Practice Address - Street 1:2717 N STEVES BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3959
Practice Address - Country:US
Practice Address - Phone:928-526-2968
Practice Address - Fax:928-526-0708
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZLPC-2543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional