Healthcare Provider Details

I. General information

NPI: 1538972633
Provider Name (Legal Business Name): WELLSPRING COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 N BROADWAY STE 327
EDMOND OK
73034-4177
US

IV. Provider business mailing address

2524 N BROADWAY STE 327
EDMOND OK
73034-4177
US

V. Phone/Fax

Practice location:
  • Phone: 405-548-5622
  • Fax:
Mailing address:
  • Phone: 405-548-5622
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CALYE MORGAN BOWEN
Title or Position: OWNER/DIRECTOR
Credential: LPC-S
Phone: 405-548-5622