Provider Demographics
NPI:1619488566
Name:WELLS, BREE DANIELLE
Entity Type:Individual
Prefix:
First Name:BREE
Middle Name:DANIELLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4489 N DRESDEN PL STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5004
Mailing Address - Country:US
Mailing Address - Phone:208-321-7360
Mailing Address - Fax:208-906-0811
Practice Address - Street 1:4489 N DRESDEN PL STE 102
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-5004
Practice Address - Country:US
Practice Address - Phone:208-321-7360
Practice Address - Fax:208-906-0811
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6680101YP2500X
IDLCPC7505101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional