Healthcare Provider Details

I. General information

NPI: 1962424887
Provider Name (Legal Business Name): WELLSPRING COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW SUITE 254
GRAND RAPIDS MI
49505-4671
US

IV. Provider business mailing address

1345 MONROE AVE NW SUITE 254
GRAND RAPIDS MI
49505-4671
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-3341
  • Fax: 616-874-9197
Mailing address:
  • Phone: 616-460-3341
  • Fax: 616-874-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLY JAMES BONEWELL
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LPC
Phone: 616-460-3341