Provider Demographics
NPI:1477877520
Name:WELLS, DESLEY DIANE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DESLEY
Middle Name:DIANE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HUNTERS RUN CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1073
Mailing Address - Country:US
Mailing Address - Phone:636-399-4075
Mailing Address - Fax:
Practice Address - Street 1:1340 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-1943
Practice Address - Country:US
Practice Address - Phone:314-854-5736
Practice Address - Fax:314-854-5750
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090087181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical