Provider Demographics
NPI:1154193258
Name:WELLS, RIAN MARIN
Entity type:Individual
Prefix:
First Name:RIAN
Middle Name:MARIN
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W 400 S APT 321
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4630
Mailing Address - Country:US
Mailing Address - Phone:385-307-5140
Mailing Address - Fax:
Practice Address - Street 1:165 N 1330 W STE A1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-5116
Practice Address - Country:US
Practice Address - Phone:801-960-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker