Provider Demographics
NPI:1629437496
Name:WEND, MADELINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:
Last Name:WEND
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 1:7361 BRIGHTWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4323
Mailing Address - Country:US
Mailing Address - Phone:817-301-7374
Mailing Address - Fax:
Practice Address - Street 1:955 FOREST ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3401
Practice Address - Country:US
Practice Address - Phone:302-760-9736
Practice Address - Fax:302-329-3107
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72380101YM0800X
DEPC-0011362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health