MEDICARE: WELLSPRING CHRISTIAN CLINIC, INC.

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	103TC0700X	Clinical Psychologist	889	AL

General Provider Information

NPI Number	:	1962526301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRING CHRISTIAN CLINIC, INC.

Provider Business Mailing Address
First Line	:	3104 BLUE LAKE DR
Second Line	:	SUITE 100
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2345
Country	:	US
Telephone Number	:	205-977-3003
Fax Number	:	205-977-3939

Provider Business Practice Location Address
First Line	:	3104 BLUE LAKE DR
Second Line	:	SUITE 100
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2345
Country	:	US
Telephone Number	:	205-977-3003
Fax Number	:	205-977-3939

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. THOMAS AL SAUNDERS JR.
Credential	:	PSY.D.
Telephone Number	:	205-977-3003

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	04/06/2012

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