Basic Information
| Provider Information | |||||||||
| NPI: | 1730330598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MSW, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 GRANT AVE | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488012221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894634587 | ||||||||
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| Practice Location | |||||||||
| Address1: | 320 E WARWICK DR | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488011014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894634971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 10/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801017283 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.