Provider Demographics
NPI:1639354707
Name:WELLS, JASON R (PSYD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:WELLS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-1297
Mailing Address - Country:US
Mailing Address - Phone:913-367-1593
Mailing Address - Fax:913-367-1627
Practice Address - Street 1:1301 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1297
Practice Address - Country:US
Practice Address - Phone:913-367-1593
Practice Address - Fax:913-367-1627
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical