Provider Demographics
NPI:1598560666
Name:KIMBERLY WELLS COUNSELING LLC
Entity type:Organization
Organization Name:KIMBERLY WELLS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-280-8113
Mailing Address - Street 1:109 S LAREDO AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-4853
Mailing Address - Country:US
Mailing Address - Phone:479-280-8113
Mailing Address - Fax:479-431-5014
Practice Address - Street 1:109 S LAREDO AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-4853
Practice Address - Country:US
Practice Address - Phone:479-280-8113
Practice Address - Fax:479-431-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty