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General NPI Number Information
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NPI Number | 1841655545
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Entity Type | Organization
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Legal Business Name | WELLSPRING PSYCHOLOGY PC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 475 ALBERTO WAY STE 180
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City | LOS GATOS
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State | CA
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Zip | 95032-5481
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Country | US
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Telephone | 408-357-4102
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Fax | 408-550-1879
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Provider Business Mailing Address
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Address Line | 475 ALBERTO WAY STE 180
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City | LOS GATOS
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State | CA
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Zip | 95032-5481
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Country | US
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Telephone | 408-357-4102
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Fax | 408-550-1879
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD JOSHUA MADDOX
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Credential | PH.D.
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Telephone | 408-357-4102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY25909
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License Number State | CA
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