Provider Demographics
NPI:1770609133
Name:WELLMAN, DEBORAH (MA, LCPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 12TH AVE RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5013
Mailing Address - Country:US
Mailing Address - Phone:208-467-5009
Mailing Address - Fax:208-467-3945
Practice Address - Street 1:228 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5013
Practice Address - Country:US
Practice Address - Phone:208-467-5009
Practice Address - Fax:208-467-3945
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID27101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor