Provider Demographics
NPI:1043991409
Name:WELLS, MUTA (LPC, LCDC)
Entity Type:Individual
Prefix:MR
First Name:MUTA
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 STATE HIGHWAY 121 STE 930
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9347
Mailing Address - Country:US
Mailing Address - Phone:469-200-4093
Mailing Address - Fax:469-200-4079
Practice Address - Street 1:11500 STATE HIGHWAY 121 STE 510
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9348
Practice Address - Country:US
Practice Address - Phone:469-200-4093
Practice Address - Fax:469-200-4079
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15118101YA0400X
TX81446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)