Provider Demographics
NPI:1679907075
Name:WELLS MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:WELLS MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:ALDEN KAIAO
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MSCP, NCC, LMHC
Authorized Official - Phone:808-222-3588
Mailing Address - Street 1:40 AULIKE ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2758
Mailing Address - Country:US
Mailing Address - Phone:808-222-3588
Mailing Address - Fax:808-262-2747
Practice Address - Street 1:40 AULIKE ST
Practice Address - Street 2:SUIT 411
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2758
Practice Address - Country:US
Practice Address - Phone:808-222-3588
Practice Address - Fax:808-262-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC - 263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty