Healthcare Provider Details

I. General information

NPI: 1427223064
Provider Name (Legal Business Name): THE WELLSPRING ALLIANCE FOR FAMILIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 ROYAL AVE
MONROE LA
71201-5724
US

IV. Provider business mailing address

1904 ROYAL AVE
MONROE LA
71201-5724
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-1505
  • Fax: 318-323-1361
Mailing address:
  • Phone: 318-323-1505
  • Fax: 318-323-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA LONGENBAUGH
Title or Position: SUPERVISOR
Credential:
Phone: 318-323-1505