Provider Demographics
NPI:1841063286
Name:WELL COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:WELL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-229-3345
Mailing Address - Street 1:900 MATISSE DR APT 5013
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2478
Mailing Address - Country:US
Mailing Address - Phone:817-229-3345
Mailing Address - Fax:
Practice Address - Street 1:900 MATISSE DR APT 5013
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2478
Practice Address - Country:US
Practice Address - Phone:817-229-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty