Provider Demographics
NPI:1730660853
Name:WELLS, EDWARD LEE (LEP, LMFT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:WELLS
Suffix:
Gender:M
Credentials:LEP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24411 AMADOR ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1301
Mailing Address - Country:US
Mailing Address - Phone:510-784-2611
Mailing Address - Fax:510-784-2629
Practice Address - Street 1:27035 WHITMAN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4027
Practice Address - Country:US
Practice Address - Phone:510-723-3190
Practice Address - Fax:510-582-0964
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87423106H00000X
CA3212103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist