Provider Demographics
NPI:1740606896
Name:WELLS, ELIZABETH (COUNSELOR /THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:COUNSELOR /THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 COLLINGWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-1173
Mailing Address - Country:US
Mailing Address - Phone:419-255-9585
Mailing Address - Fax:
Practice Address - Street 1:4913 HARROUN RD STE 3
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2102
Practice Address - Country:US
Practice Address - Phone:419-841-3003
Practice Address - Fax:419-841-3390
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1801148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional