Provider Demographics
NPI:1962850339
Name:WELLENCE, MARY ELIZABETH T (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:T
Last Name:WELLENCE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3829 FOREST PARK WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-3762
Mailing Address - Country:US
Mailing Address - Phone:716-812-8370
Mailing Address - Fax:716-304-1430
Practice Address - Street 1:3829 FOREST PARK WAY STE 100
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-3762
Practice Address - Country:US
Practice Address - Phone:716-812-8370
Practice Address - Fax:716-304-1430
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006799101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health