Provider Demographics
NPI:1053982512
Name:WELLS, KIMBERLY R (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2206000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP2206000OtherSTATE