Provider Demographics
NPI:1538116587
Name:WELLS, DAVID SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:WELLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 EXECUTIVE PARK DR.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4000
Mailing Address - Country:US
Mailing Address - Phone:513-771-8555
Mailing Address - Fax:513-771-8556
Practice Address - Street 1:4100 EXECUTIVE PARK DR.
Practice Address - Street 2:SUITE 9
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4000
Practice Address - Country:US
Practice Address - Phone:513-771-8555
Practice Address - Fax:513-771-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWECP30411Medicare ID - Type Unspecified