Healthcare Provider Details

I. General information

NPI: 1669693065
Provider Name (Legal Business Name): WELLSPRING CHRISTIAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 THE PINES CT SUITE A
SAINT LOUIS MO
63141-6199
US

IV. Provider business mailing address

9 THE PINES CT SUITE A
SAINT LOUIS MO
63141-6199
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-5425
  • Fax: 314-878-5632
Mailing address:
  • Phone: 314-878-5425
  • Fax: 314-878-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMO

VIII. Authorized Official

Name: JEFF OBERLE
Title or Position: DIRECTOR OF ADMINISTRATION
Credential: LPC
Phone: 314-604-5622