Provider Demographics
NPI:1669970554
Name:WELLS, ARIEL (BCBA)
Entity type:Individual
Prefix:MS
First Name:ARIEL
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 WOODMAN AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1384
Mailing Address - Country:US
Mailing Address - Phone:708-665-1812
Mailing Address - Fax:
Practice Address - Street 1:5318 LAUREL CANYON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-4928
Practice Address - Country:US
Practice Address - Phone:818-423-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1728575103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-17-28575OtherBEHAVIOR ANALYST CERTIFICATION BOARD