Provider Demographics
NPI:1588007496
Name:WELLS, TIESA MARIE (AAS, BS)
Entity Type:Individual
Prefix:MRS
First Name:TIESA
Middle Name:MARIE
Last Name:WELLS
Suffix:
Gender:F
Credentials:AAS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 CHESHIRE AVE.
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:541-343-2993
Mailing Address - Fax:541-343-2338
Practice Address - Street 1:687 CHESHIRE AVE.
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-343-2993
Practice Address - Fax:541-343-2338
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health