Provider Demographics
NPI:1225562317
Name:WELLSPRING BEHAVIORAL HEALTH PC
Entity Type:Organization
Organization Name:WELLSPRING BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEELY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:512-302-1590
Mailing Address - Street 1:12741 RESEARCH BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4388
Mailing Address - Country:US
Mailing Address - Phone:512-302-1590
Mailing Address - Fax:877-369-4844
Practice Address - Street 1:12741 RESEARCH BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4388
Practice Address - Country:US
Practice Address - Phone:512-302-1590
Practice Address - Fax:877-369-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36188103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty