Provider Demographics
NPI:1093185951
Name:WELLSPRING BRANCH COUNSELING AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:WELLSPRING BRANCH COUNSELING AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-551-0836
Mailing Address - Street 1:2085 SUNSET LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9280
Mailing Address - Country:US
Mailing Address - Phone:956-551-0836
Mailing Address - Fax:
Practice Address - Street 1:2085 SUNSET LAKE DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-9280
Practice Address - Country:US
Practice Address - Phone:956-551-0836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-04
Last Update Date:2015-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68897261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health