Provider Demographics
NPI:1598139958
Name:WELLS, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1841
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71284-1841
Mailing Address - Country:US
Mailing Address - Phone:225-223-2235
Mailing Address - Fax:318-467-2400
Practice Address - Street 1:210 EE WALLACE BLVD N STE 3
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-2822
Practice Address - Country:US
Practice Address - Phone:318-757-0016
Practice Address - Fax:318-757-0011
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor