Provider Demographics
NPI:1609814474
Name:WELLS, JOAN CHRISTINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:CHRISTINE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:CHRISTINE
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2536 N JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-1266
Mailing Address - Country:US
Mailing Address - Phone:417-818-6006
Mailing Address - Fax:
Practice Address - Street 1:309 N JEFFERSON AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1108
Practice Address - Country:US
Practice Address - Phone:417-818-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000169672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional