Provider Demographics
NPI:1205580578
Name:WELLS, DANYELL NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:DANYELL
Middle Name:NICOLE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 HIGHWAY 287 N STE 311
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2765
Mailing Address - Country:US
Mailing Address - Phone:601-307-1220
Mailing Address - Fax:
Practice Address - Street 1:733 HIGHWAY 287 N STE 311
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2765
Practice Address - Country:US
Practice Address - Phone:972-333-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107040104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty