Provider Demographics
NPI:1487046173
Name:WELLS, SHIRLEY EF (IMFT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:EF
Last Name:WELLS
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 W 130TH ST APT 219E
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7861
Mailing Address - Country:US
Mailing Address - Phone:502-938-4284
Mailing Address - Fax:
Practice Address - Street 1:11565 PEARL RD STE 200
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3356
Practice Address - Country:US
Practice Address - Phone:888-830-0347
Practice Address - Fax:513-939-0310
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00209256106H00000X
OHF.1900089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0481470Medicaid