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General NPI Number Information
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NPI Number | 1568848919
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Entity Type | Organization
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Legal Business Name | WELLSPRING BEHAVIOR CONSULTING, LLC
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Dates
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Enumeration Date | 08/08/2015
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 5170 GOLDEN FOOTHILL PKWY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9608
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Country | US
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Telephone | 916-250-3263
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Fax | 916-692-1460
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Provider Business Mailing Address
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Address Line | 5170 GOLDEN FOOTHILL PKWY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9608
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Country | US
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Telephone | 916-250-3263
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Fax | 916-692-1460
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JASON GILBERT
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Credential |
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Telephone | 916-250-3263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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