Provider Demographics
NPI:1316242985
Name:WELLS, LURLINE (MFT-I)
Entity type:Individual
Prefix:MRS
First Name:LURLINE
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 W CHARLESTON BLVD
Mailing Address - Street 2:#23
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1942
Mailing Address - Country:US
Mailing Address - Phone:702-437-4673
Mailing Address - Fax:702-438-4673
Practice Address - Street 1:2820 W CHARLESTON BLVD
Practice Address - Street 2:#23
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:702-437-4673
Practice Address - Fax:702-438-4673
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01255-L101YA0400X
NVMI0765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV01255-LOtherLICENSED ALCOHOL AND DRUG COUNSELOR
NVMI0222OtherMARRIAGE AND FAMILY INTERN