Provider Demographics
NPI:1780690834
Name:WELLS, MONA SUE (LCSW,LMHP)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:SUE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW,LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 A ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4289
Mailing Address - Country:US
Mailing Address - Phone:402-488-6120
Mailing Address - Fax:402-488-6140
Practice Address - Street 1:7121 A ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4289
Practice Address - Country:US
Practice Address - Phone:402-488-6120
Practice Address - Fax:402-488-6140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82217OtherPROVIDER