Provider Demographics
NPI:1689005845
Name:WELLS, ROSEMARY (LPC)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:UT
Mailing Address - Zip Code:84716-1480
Mailing Address - Country:US
Mailing Address - Phone:208-815-0042
Mailing Address - Fax:
Practice Address - Street 1:4685 NAVAJO ST.
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:UT
Practice Address - Zip Code:84716
Practice Address - Country:US
Practice Address - Phone:208-815-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC6832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional