Provider Demographics
NPI:1528186517
Name:WELLS, BRANDON A (MS, LPC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:A
Last Name:WELLS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1215
Mailing Address - Country:US
Mailing Address - Phone:414-810-9012
Mailing Address - Fax:
Practice Address - Street 1:4530 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53211-1215
Practice Address - Country:US
Practice Address - Phone:414-810-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2844-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health