Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301016657 | MI |
Y | 103T00000X | Psychologist | 6301016657 | MI |
NPI | 1003372368 |
---|---|
Provider Name | Chelsea Kae Wells |
First Address | Brooklyn, MI 49230-9528 |
Second Address | Jackson, MI 49201-9322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2019 |
Last Update Date | 12/02/2019 |