MEDICARE: WELLSPRING COUNSELING

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1962424887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING COUNSELING

Provider Business Mailing Address
First Line	:	1345 MONROE AVE NW
Second Line	:	SUITE 254
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4671
Country	:	US
Telephone Number	:	616-460-3341
Fax Number	:	616-874-9197

Provider Business Practice Location Address
First Line	:	1345 MONROE AVE NW
Second Line	:	SUITE 254
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-4671
Country	:	US
Telephone Number	:	616-460-3341
Fax Number	:	616-874-9197

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KELLY JAMES BONEWELL
Credential	:	MA, LPC
Telephone Number	:	616-460-3341

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/22/2020

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Directions to “WELLSPRING COUNSELING ” Practice Location

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