Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2002013515 | MO |
NPI | 1003001504 |
---|---|
Provider Name | Ms. Shirley Ann Wells |
First Address | Saint Louis, MO 63121-2436 |
Second Address | Saint Louis, MO 63139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2007 |
Last Update Date | 21/09/2009 |