Healthcare Provider Details

I. General information

NPI: 1356389282
Provider Name (Legal Business Name): WELLSPRING HEALTHCARE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N 2ND ST
ROGERS AR
72756-6647
US

IV. Provider business mailing address

324 N 2ND ST
ROGERS AR
72756-6647
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-0566
  • Fax: 479-986-0599
Mailing address:
  • Phone: 479-986-0566
  • Fax: 479-986-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE THOMPSON
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 479-986-0566