Provider Demographics
NPI:1366780157
Name:WELLS, AMANDA RAYE
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RAYE
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 1:1900 NE DIVISION ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3572
Mailing Address - Country:US
Mailing Address - Phone:541-516-6330
Mailing Address - Fax:
Practice Address - Street 1:1900 NE DIVISION ST STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3572
Practice Address - Country:US
Practice Address - Phone:541-516-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health