Provider Demographics
NPI:1407378771
Name:WELLS, ROBERT DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:WELLS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W SHAW AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3708
Mailing Address - Country:US
Mailing Address - Phone:559-228-1618
Mailing Address - Fax:559-228-1004
Practice Address - Street 1:1100 W SHAW AVE STE 134
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3708
Practice Address - Country:US
Practice Address - Phone:559-228-1618
Practice Address - Fax:559-228-1004
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical