Provider Demographics
NPI:1831960566
Name:WELLS, DESTINEE MANUELA
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:MANUELA
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 SHADOW CREEK PKWY STE 111-659
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7283
Mailing Address - Country:US
Mailing Address - Phone:713-581-4527
Mailing Address - Fax:
Practice Address - Street 1:11601 SHADOW CREEK PKWY STE 111-659
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7283
Practice Address - Country:US
Practice Address - Phone:713-581-4527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX93524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health