Provider Demographics
NPI:1134774441
Name:WELLS, ELIZABETH ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4512 ST. CLAIR AVE.
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604
Mailing Address - Country:US
Mailing Address - Phone:818-753-9953
Mailing Address - Fax:
Practice Address - Street 1:4512 ST. CLAIR AVE.
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604
Practice Address - Country:US
Practice Address - Phone:818-753-9953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW900941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical