| Doctor Name: | AMY WELLS |
| NPI Number: | 1063769651 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.I.S.W. |
| License Number: | I1200894 |
| Business Practice Address: | 347 Midway Blvd Suite 204 Lorain, OH - 440532496 |
| Business Phone Number: | 4403244980 |
| Business Fax Number: | 2163783906 |
| Mailing Address: | 6140 S Broadway, LORAIN |
| State: | OH |
| Postal Code: | 440533821 |
| Phone Number: | 4402044364 |
| Fax Number: | 4402339070 |
| NPI Enumeration Date: | 08/14/2012 |
| NPI Last Update Date: | 12/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | I1200894 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |