Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 129179 | KY |
Y | 103T00000X | Psychologist | 129179 | KY |
N | 102L00000X | Psychologist | 1433 | KY |
N | 103T00000X | Psychologist | 1433 | KY |
N | 103TC1900X | Counseling Psychologist | 1433 | KY |
NPI | 1073611554 |
---|---|
Provider Name | Robert D. Wells |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Crestview Hills, KY 41017-3464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0154652 | (05) | OH |
7100403940 | (05) | KY |