Provider Demographics
NPI:1881628782
Name:WELLS, DAVID T (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:WELLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6-B GLEN-ED PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3333
Mailing Address - Country:US
Mailing Address - Phone:618-692-9600
Mailing Address - Fax:618-692-9607
Practice Address - Street 1:6-B GLEN-ED PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3333
Practice Address - Country:US
Practice Address - Phone:618-692-9600
Practice Address - Fax:618-692-9607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14842OtherBCBS MO
IL6072011OtherBCBS IL
IL6111855OtherUNITED HEALTHCARE
IL126302OtherHEALTHLINK
ILR18036OtherMERCY HEALTH PLANS
IL048560OtherVALUE OPTIONS
IL1733254OtherFIRST HEALTH
IL5823117OtherAETNA
IL6111855OtherUNITED HEALTHCARE