Provider Demographics
NPI:1255354098
Name:WELLS, KATHARINA (LMFT, LPCC, RN)
Entity type:Individual
Prefix:MS
First Name:KATHARINA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMFT, LPCC, RN
Other - Prefix:
Other - First Name:KATHARINA
Other - Middle Name:
Other - Last Name:SELLENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29640 N. 132ND DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383
Mailing Address - Country:US
Mailing Address - Phone:714-345-2172
Mailing Address - Fax:
Practice Address - Street 1:18205 N. 51ST. AVE, SUITE 109
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:714-345-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZLPC19343101YP2500X
CALPC2006101YP2500X
CACAMFT34230106H00000X
CAMFT34230106H00000X
AZAZRN249135163WP0808X
CARN330115163WP0808X
AZAZMFT15530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health