Provider Demographics
NPI:1396572293
Name:WELLS, KYLE AIDEN
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:AIDEN
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E HIGHLINE CIR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1019
Mailing Address - Country:US
Mailing Address - Phone:720-243-8233
Mailing Address - Fax:
Practice Address - Street 1:1675 18TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5151
Practice Address - Country:US
Practice Address - Phone:970-815-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician