Provider Demographics
NPI:1760919468
Name:WELLS, MAKAYLA EARL
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:EARL
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5728 SANDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5421
Mailing Address - Country:US
Mailing Address - Phone:386-453-6250
Mailing Address - Fax:
Practice Address - Street 1:5728 SANDSTONE WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5421
Practice Address - Country:US
Practice Address - Phone:386-453-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE640-557-94-525-0106S00000X
FL1-20-41462103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician