Healthcare Provider Details

I. General information

NPI: 1558279901
Provider Name (Legal Business Name): WELLSPRING BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 VINE ST
BRAINERD MN
56401-4058
US

IV. Provider business mailing address

603 VINE ST
BRAINERD MN
56401-4058
US

V. Phone/Fax

Practice location:
  • Phone: 218-394-7155
  • Fax:
Mailing address:
  • Phone: 218-394-7155
  • Fax: 218-551-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMANTHA COLE
Title or Position: CO-OWNER/PSYCHOTHERAPIST
Credential: LMFT
Phone: 218-831-4550