Provider Demographics
NPI:1306168703
Name:WELLHOEFER, RYAN DANIEL (MC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIEL
Last Name:WELLHOEFER
Suffix:
Gender:M
Credentials:MC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 PINECROFT DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3286
Mailing Address - Country:US
Mailing Address - Phone:713-677-4121
Mailing Address - Fax:
Practice Address - Street 1:9200 PINECROFT DR STE 250
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3286
Practice Address - Country:US
Practice Address - Phone:713-677-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX67977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor