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General NPI Number Information
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NPI Number | 1356704993
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Entity Type | Individual
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Provider Name | DOUG WELLS LPC
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Gender | Male
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 501 PINE TREE RD # A-6
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City | LONGVIEW
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State | TX
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Zip | 75604-4000
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Country | US
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Telephone | 903-201-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 510 E LOOP 281 STE B101
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City | LONGVIEW
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State | TX
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Zip | 75605-5077
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Country | US
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Telephone | 430-201-4646
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Fax | 903-797-9070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 72526
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License Number State | TX
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