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Provider Information for 1679211130


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Mr. ROBERT WELLS LCSW


Sex: Male

NPI: 1679211130
Last Updated: 2022-05-24
Certification Date: 2022-05-24

Details

NameValue
NPI1679211130
Enumeration Date2022-05-24
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 3321 SW SENSATION DR APT 523
LEES SUMMIT, MO 64081-7807
United States

Phone: 816-668-8502 | Fax:
 
Primary Practice Address 3321 SW SENSATION DR APT 523
LEES SUMMIT, MO 64081-7807
United States

Phone: 816-668-8502 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalKS05336