Provider Demographics
NPI:1730303041
Name:WELLS, JOAN BARNARD (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BARNARD
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 1:3247 SWANDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4439
Mailing Address - Country:US
Mailing Address - Phone:210-203-2057
Mailing Address - Fax:210-308-6989
Practice Address - Street 1:5602 CHARLIE CHAN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2307
Practice Address - Country:US
Practice Address - Phone:210-203-2057
Practice Address - Fax:210-681-9153
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10507101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0269680-01Medicaid