Basic Information
| Provider Information | |||||||||
| NPI: | 1942540679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | DARYL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1740 BARONNE ST | ||||||||
| Address2: | #250 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701131349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097895995 | ||||||||
| FaxNumber: | 5043223848 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 POYDRAS ST | ||||||||
| Address2: | STE. 1780 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701303245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043223837 | ||||||||
| FaxNumber: | 5043223848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2013 | ||||||||
| LastUpdateDate: | 02/16/2013 | ||||||||
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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 | 101YM0800X | 4883 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.