Healthcare Provider Details

I. General information

NPI: 1093740573
Provider Name (Legal Business Name): WELLSPRING FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RAINIER AVE S
SEATTLE WA
98144-4606
US

IV. Provider business mailing address

1900 RAINIER AVE S
SEATTLE WA
98144-4606
US

V. Phone/Fax

Practice location:
  • Phone: 206-826-3050
  • Fax: 877-903-0711
Mailing address:
  • Phone: 206-826-3050
  • Fax: 877-903-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD KEITH MYERS
Title or Position: VICE PRESIDENT
Credential: LICSW
Phone: 425-826-3035