Provider Demographics
NPI:1316144785
Name:WELLS, JANEEN LEALICE (LPC)
Entity type:Individual
Prefix:MS
First Name:JANEEN
Middle Name:LEALICE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15396 N 83RD AVE
Mailing Address - Street 2:BLDG E
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5622
Mailing Address - Country:US
Mailing Address - Phone:623-234-3638
Mailing Address - Fax:623-234-4606
Practice Address - Street 1:15396 N 83RD AVE
Practice Address - Street 2:BLDG E
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5622
Practice Address - Country:US
Practice Address - Phone:623-234-3638
Practice Address - Fax:623-234-4606
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC11954101YM0800X
AZLPC 13389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC11954OtherLICENSE