MEDICARE: WELLSPRING COUNSELING CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700028503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	4305 S GREEN BAY RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-9425
Country	:	US
Telephone Number	:	262-554-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 S GREEN BAY RD
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-9425
Country	:	US
Telephone Number	:	262-554-7215
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	BRIAN WESTRATE
Credential	:
Telephone Number	:	262-883-9400

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	10/23/2019

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