1912126129 NPI number — MRS. BEATRICE BROWN WELLS LCSW

Table of content: MRS. BEATRICE BROWN WELLS LCSW (NPI 1912126129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912126129 NPI number — MRS. BEATRICE BROWN WELLS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN WELLS
Provider First Name:
BEATRICE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
BEATRICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912126129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 474
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71326-0474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-324-2994
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 EE WALLACE BLVD N STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERRIDAY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71334-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-324-2994
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4921 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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