Healthcare Provider Details

I. General information

NPI: 1881178176
Provider Name (Legal Business Name): WELLSPRING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FAIRLANE DR
LAFAYETTE TN
37083-1709
US

IV. Provider business mailing address

300 FAIRLANE DR
LAFAYETTE TN
37083-1709
US

V. Phone/Fax

Practice location:
  • Phone: 615-688-9504
  • Fax: 615-688-9503
Mailing address:
  • Phone: 615-688-9504
  • Fax: 615-688-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLY HALE
Title or Position: OWNER
Credential: PHD, BCBA, LBA
Phone: 615-688-9504