Provider Demographics
NPI:1780952606
Name:WELLS, JULIA J (CDP)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:J
Last Name:WELLS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4318
Mailing Address - Country:US
Mailing Address - Phone:509-895-7740
Mailing Address - Fax:509-895-7750
Practice Address - Street 1:506 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4318
Practice Address - Country:US
Practice Address - Phone:509-895-7740
Practice Address - Fax:509-895-7750
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60511801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)