Provider Demographics
NPI:1629758990
Name:WELLS, JAMES ALBERT SR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:WELLS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 W EXCHANGE PKWY APT 5206
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7040
Mailing Address - Country:US
Mailing Address - Phone:214-755-4111
Mailing Address - Fax:
Practice Address - Street 1:1089 W EXCHANGE PKWY APT 5206
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7040
Practice Address - Country:US
Practice Address - Phone:214-755-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health