Provider Demographics
NPI:1972810828
Name:WELLS, HEIDI KRISTEN (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:KRISTEN
Last Name:WELLS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16480 HARBOR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1361
Mailing Address - Country:US
Mailing Address - Phone:714-884-4408
Mailing Address - Fax:
Practice Address - Street 1:1292 PAGE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3064
Practice Address - Country:US
Practice Address - Phone:415-621-2929
Practice Address - Fax:415-621-4758
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #49085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist