Healthcare Provider Details

I. General information

NPI: 1174487409
Provider Name (Legal Business Name): THE WELLSPRING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S 7TH ST UNIT B
HOTCHKISS CO
81419-0481
US

IV. Provider business mailing address

PO BOX 508
HOTCHKISS CO
81419-0508
US

V. Phone/Fax

Practice location:
  • Phone: 970-872-9355
  • Fax:
Mailing address:
  • Phone: 970-872-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELISABETH EVANS
Title or Position: MST
Credential:
Phone: 970-773-4728