Provider Demographics
NPI:1194934422
Name:WELLS, BETTE EVANS (MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:BETTE
Middle Name:EVANS
Last Name:WELLS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 DEER CREEK ALBA WAY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7932
Mailing Address - Country:US
Mailing Address - Phone:954-427-8420
Mailing Address - Fax:954-427-8491
Practice Address - Street 1:10 FAIRWAY DR STE 217
Practice Address - Street 2:HILLSBORO BOULEVARD
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1802
Practice Address - Country:US
Practice Address - Phone:954-941-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1246OtherBLUE CROSS & BLUE SHIELD