Provider Demographics
NPI:1699842377
Name:WELLS, ANNE M (PHD,HSPP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHD,HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-2403
Mailing Address - Country:US
Mailing Address - Phone:219-887-3688
Mailing Address - Fax:
Practice Address - Street 1:4795 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-2403
Practice Address - Country:US
Practice Address - Phone:219-887-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041315A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist