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General NPI Number Information
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NPI Number | 1043468010
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Entity Type | Organization
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Legal Business Name | WELLSPRING FAMILY COUNSELING, PLLC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1227 N VALLEY MILLS DR SUITE 206
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City | WACO
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State | TX
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Zip | 76710-4427
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Country | US
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Telephone | 254-751-1164
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Fax |
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Provider Business Mailing Address
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Address Line | 1227 N VALLEY MILLS DR SUITE 206
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City | WACO
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State | TX
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Zip | 76710-4427
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Country | US
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Telephone | 254-751-1164
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Fax |
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Authorized Official
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Title or Position | LPC/OWNER
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Name | JAMES DEREK SLOVER
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Credential | M.A., LPC
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Telephone | 254-855-7699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 62399
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License Number State | TX
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