Provider Demographics
NPI:1659549988
Name:WELLS, CASEY MICHELLE (MS, PLPC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MICHELLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MICHELLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5272 HILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7231
Mailing Address - Country:US
Mailing Address - Phone:573-760-7000
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 2335
Practice Address - Street 2:
Practice Address - City:SEDGEWICKVILLE
Practice Address - State:MO
Practice Address - Zip Code:63781-9706
Practice Address - Country:US
Practice Address - Phone:573-330-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012007106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional