Provider Demographics
NPI:1356704993
Name:WELLS, DOUG (LPC)
Entity type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 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:903-201-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional