Provider Demographics
NPI:1396053526
Name:WELLS, NANCY ELIZABETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2758 E MILLENNIUM PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4798
Mailing Address - Country:US
Mailing Address - Phone:479-957-2121
Mailing Address - Fax:479-442-4897
Practice Address - Street 1:2758 E MILLENNIUM PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4798
Practice Address - Country:US
Practice Address - Phone:479-957-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1310098101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183403795Medicaid