| Doctor Name: | KENNETH BECKETT WELLS |
| NPI Number: | 1023161080 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.P.C. |
| License Number: | LISAC-10875 |
| Business Practice Address: | 15627 E Centipede Dr Fountain Hills, AZ - 852681530 |
| Business Phone Number: | 4802051806 |
| Business Fax Number: | 4808165521 |
| Mailing Address: | 15627 E Centipede Dr, FOUNTAIN HILLS |
| State: | AZ |
| Postal Code: | 852681530 |
| Phone Number: | 4802051806 |
| Fax Number: | 4808165521 |
| NPI Enumeration Date: | 01/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LISAC-10875 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |