Provider Demographics
NPI:1679360689
Name:WELLS, KENDRA CHRISTINE
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:CHRISTINE
Last Name:WELLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 DIAMOND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5434
Mailing Address - Country:US
Mailing Address - Phone:530-999-1554
Mailing Address - Fax:
Practice Address - Street 1:2030 HARTNELL AVE STE D
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-5070
Practice Address - Country:US
Practice Address - Phone:530-255-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist