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General NPI Number Information
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NPI Number | 1427561299
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Entity Type | Organization
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Legal Business Name | WELLSPRING CENTER FOR COUNSELING, LLC
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 240 EDWARD ST
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City | SYCAMORE
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State | IL
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Zip | 60178-2155
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Country | US
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Telephone | 402-750-0279
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Fax |
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Provider Business Mailing Address
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Address Line | 9N550 CREEKWOOD CT
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City | ELGIN
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State | IL
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Zip | 60124-8331
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Country | US
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Telephone | 402-750-0279
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | MRS. HALIE HOWELLS
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Credential | LMFT
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Telephone | 402-750-0279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 166000970
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License Number State | IL
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