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General NPI Number Information
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NPI Number | 1912891433
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Entity Type | Organization
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Legal Business Name | WELLSPACE LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 1523 E BOISE AVE
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City | BOISE
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State | ID
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Zip | 83706-5064
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Country | US
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Telephone | 208-918-2588
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Fax |
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Provider Business Mailing Address
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Address Line | 6568 S FEDERAL WAY STE 241
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City | BOISE
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State | ID
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Zip | 83716-9277
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Country | US
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Telephone | 208-918-2588
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. APRIL V ROSE
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Credential | PSYD
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Telephone | 208-918-2588
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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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