Basic Information
| Provider Information | |||||||||
| NPI: | 1982842027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | LISW, LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7261 MERCY RD. | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023986248 | ||||||||
| FaxNumber: | 4028298513 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 HARMONY ST | ||||||||
| Address2: | |||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515033106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123282609 | ||||||||
| FaxNumber: | 7123289257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2009 | ||||||||
| LastUpdateDate: | 11/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801090904 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 087606 | IA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.