Healthcare Provider Details

I. General information

NPI: 1700467115
Provider Name (Legal Business Name): WELLSPRING COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4843 HORTON ST
MISSION KS
66202-1758
US

IV. Provider business mailing address

PO BOX 1265
MISSION KS
66222-0265
US

V. Phone/Fax

Practice location:
  • Phone: 913-735-3020
  • Fax:
Mailing address:
  • Phone: 913-735-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JILLIAN FIELDS
Title or Position: OWNER
Credential: LPC
Phone: 913-735-3020