Provider Demographics
NPI:1023161080
Name:WELLS, KENNETH BECKETT (LPC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BECKETT
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15627 E CENTIPEDE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-1530
Mailing Address - Country:US
Mailing Address - Phone:480-205-1806
Mailing Address - Fax:480-816-5521
Practice Address - Street 1:15627 E CENTIPEDE DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-1530
Practice Address - Country:US
Practice Address - Phone:480-205-1806
Practice Address - Fax:480-816-5521
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10875101YA0400X
AZLPC-10174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional