Healthcare Provider Details

I. General information

NPI: 1649487158
Provider Name (Legal Business Name): WELLSPRING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W BRECKINRIDGE ST
LOUISVILLE KY
40203-2219
US

IV. Provider business mailing address

PO BOX 1927
LOUISVILLE KY
40201-1927
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-4361
  • Fax: 502-637-4490
Mailing address:
  • Phone: 502-637-4361
  • Fax: 502-637-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHARINE R. DOBBINS
Title or Position: CEO
Credential: LCSW
Phone: 502-637-4361