Individual
GEORGETTE EUGENIA WELLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4757 N 76TH ST, MILWAUKEE, WI 53218-4732
(414) 358-4145
(414) 358-5005
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
18197
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18197
LICENSE
WI
Enumeration date
12/31/2018
Last updated
12/31/2018
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