Provider Demographics
NPI:1568137503
Name:ANDERSON WELLS, ERIN (PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ANDERSON WELLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 N CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7025
Mailing Address - Country:US
Mailing Address - Phone:813-485-5190
Mailing Address - Fax:
Practice Address - Street 1:205 S HOOVER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3533
Practice Address - Country:US
Practice Address - Phone:813-485-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1554103TS0200X
FLPY11325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool