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General NPI Number Information
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NPI Number | 1548954910
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Entity Type | Organization
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Legal Business Name | GEMSPRING THERAPY LLC
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1518 E LINCOLN AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3402
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Country | US
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Telephone | 248-677-1502
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Fax | 313-789-1664
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Provider Business Mailing Address
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Address Line | 949 W FARNUM AVE
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3107
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Country | US
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Telephone | 248-677-1502
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Fax | 313-789-1664
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Authorized Official
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Title or Position | FOUNDER
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Name | JASPER WURSTER
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Credential | LPC, LCPC
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Telephone | 248-677-1502
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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 |
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License Number State |
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Taxonomy #2
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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 #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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