Provider Demographics
NPI:1740567114
Name:WELLS, COURTNEY DAWN (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:DAWN
Last Name:WELLS
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483-0401
Mailing Address - Country:US
Mailing Address - Phone:210-416-4919
Mailing Address - Fax:
Practice Address - Street 1:802 N MINTER AVE
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-5357
Practice Address - Country:US
Practice Address - Phone:948-849-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional