Provider Demographics
NPI:1063958403
Name:WELLING, LISA (LCMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WELLING
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 W WILLOW GARDEN PASEO
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3874
Mailing Address - Country:US
Mailing Address - Phone:707-280-4448
Mailing Address - Fax:
Practice Address - Street 1:961 W WILLOW GARDEN PASEO
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3874
Practice Address - Country:US
Practice Address - Phone:707-280-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9850826-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health