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General NPI Number Information
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NPI Number | 1386034049
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Entity Type | Organization
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Legal Business Name | WELLSPRING WELLNESS AND MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 2500 S KANNER HWY SUITE 2
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City | STUART
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State | FL
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Zip | 34994-4600
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Country | US
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Telephone | 772-320-1555
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Fax | 772-320-1557
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Provider Business Mailing Address
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Address Line | 2500 S KANNER HWY SUITE 2
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City | STUART
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State | FL
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Zip | 34994-4600
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Country | US
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Telephone | 772-320-1555
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Fax | 772-320-1557
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Authorized Official
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Title or Position | QWNER/EXECUTIVE DIRECTOR
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Name | MS. JOAN COLLINS
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Credential |
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Telephone | 772-320-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1943AD531301
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License Number State | OH
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