Provider Demographics
NPI:1043468010
Name:WELLSPRING FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:WELLSPRING FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:SLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:254-855-7699
Mailing Address - Street 1:1227 N VALLEY MILLS DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4427
Mailing Address - Country:US
Mailing Address - Phone:254-751-1164
Mailing Address - Fax:
Practice Address - Street 1:1227 N VALLEY MILLS DR
Practice Address - Street 2:SUITE 206
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4427
Practice Address - Country:US
Practice Address - Phone:254-751-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62399251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health