Provider Demographics
NPI:1528607025
Name:WELLS, RACHEL JENNIFER
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JENNIFER
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 1:1216 MOSSEY CUP DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5742
Mailing Address - Country:US
Mailing Address - Phone:252-558-7248
Mailing Address - Fax:
Practice Address - Street 1:1216 MOSSEY CUP DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5742
Practice Address - Country:US
Practice Address - Phone:252-558-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician