Provider Demographics
NPI:1770887028
Name:WELLS, TEKIA (LPC, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:TEKIA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:TEKIA
Other - Middle Name:M
Other - Last Name:LONGSTREET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CSAC, ICS
Mailing Address - Street 1:8215 GREENWAY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3689
Mailing Address - Country:US
Mailing Address - Phone:608-801-4741
Mailing Address - Fax:
Practice Address - Street 1:8215 GREENWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3689
Practice Address - Country:US
Practice Address - Phone:608-801-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10553-125101YP2500X
WI15751-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)