Provider Demographics
NPI:1366881526
Name:WELLS, LILLIAN A
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N SAINT CHARLES AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-4357
Mailing Address - Country:US
Mailing Address - Phone:405-816-8435
Mailing Address - Fax:
Practice Address - Street 1:1121 N SAINT CHARLES AVE APT 5
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-4357
Practice Address - Country:US
Practice Address - Phone:405-816-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health