Healthcare Provider Details

I. General information

NPI: 1215527064
Provider Name (Legal Business Name): WELLSPRINGS BEHAVIOURAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S AARON
MESA AZ
85209-3786
US

IV. Provider business mailing address

PO BOX 25444
TEMPE AZ
85285-5444
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-2191
  • Fax:
Mailing address:
  • Phone: 602-688-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IHUOMA NWOKE
Title or Position: OWNER
Credential:
Phone: 602-688-2191