MEDICARE: WELLSPRING PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1164395521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING PSYCHIATRY

Provider Business Mailing Address
First Line	:	1201 N WATSON RD # 106
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6190
Country	:	US
Telephone Number	:	807-607-3457
Fax Number	:	817-612-3234

Provider Business Practice Location Address
First Line	:	2528 RED DRAW RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2042
Country	:	US
Telephone Number	:	817-607-3457
Fax Number	:	817-612-3234

Authorized Official
Title or Position	:	NP
Name	:	TRUPHENA MORAA BWANA
Credential	:	NP
Telephone Number	:	817-607-3457

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	12/19/2025

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Directions to “WELLSPRING PSYCHIATRY ” Practice Location

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