Basic Information
| Provider Information | |||||||||
| NPI: | 1003001504 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.ED., LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7511 WARWICK DR | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631212436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143827997 | ||||||||
| FaxNumber: | 3143827997 | ||||||||
| Practice Location | |||||||||
| Address1: | 3309 S. KINGSHIGHWAY BLVD | ||||||||
| Address2: | FAMILY RESOURCE CENTER | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145341204 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2007 | ||||||||
| LastUpdateDate: | 09/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2002013515 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.