Healthcare Provider Details

I. General information

NPI: 1720502354
Provider Name (Legal Business Name): WELLSPRING COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2589 S FIVE MILE RD
BOISE ID
83709-2325
US

IV. Provider business mailing address

8358 S SLIDE CREEK LN
MERIDIAN ID
83642-7193
US

V. Phone/Fax

Practice location:
  • Phone: 208-908-6320
  • Fax: 208-908-6404
Mailing address:
  • Phone: 208-757-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LAUREEN KAY RHUMAN
Title or Position: OWNER/COUNSELOR
Credential: LCPC
Phone: 208-908-6320