Provider Demographics
NPI:1427542158
Name:WELLS, MATTHEW (LMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:LMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MORGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4852
Mailing Address - Country:US
Mailing Address - Phone:317-902-4684
Mailing Address - Fax:
Practice Address - Street 1:257 INDIANA AVE STE D6
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6180
Practice Address - Country:US
Practice Address - Phone:219-299-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000473A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health