Provider Demographics
NPI:1083914196
Name:WELLS, DAVID R (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:WELLS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 WILLIAM D FITCH PKWY STE 111
Mailing Address - Street 2:C/O CS CHRISTIAN COUNSELING
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6142
Mailing Address - Country:US
Mailing Address - Phone:979-216-3020
Mailing Address - Fax:
Practice Address - Street 1:543 WILLIAM D FITCH PKWY STE 111
Practice Address - Street 2:C/O CS CHRISTIAN COUNSELING
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6142
Practice Address - Country:US
Practice Address - Phone:979-216-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional