Provider Demographics
NPI:1356704902
Name:PSYCH FIT LLC
Entity type:Organization
Organization Name:PSYCH FIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:430-201-4646
Mailing Address - Street 1:510 E LOOP 281 STE B101
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5077
Mailing Address - Country:US
Mailing Address - Phone:430-201-4646
Mailing Address - Fax:903-797-9070
Practice Address - Street 1:501 PINE TREE RD # A-6
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-4000
Practice Address - Country:US
Practice Address - Phone:430-201-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health