Provider Demographics
NPI:1336680495
Name:WELLSPRING PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:WELLSPRING PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:LINNEA TERRANOVA, PSY.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINNEA
Authorized Official - Middle Name:ESTES
Authorized Official - Last Name:TERRANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:831-747-4390
Mailing Address - Street 1:80 GARDEN CT STE 260
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5340
Mailing Address - Country:US
Mailing Address - Phone:831-647-8490
Mailing Address - Fax:831-574-3057
Practice Address - Street 1:2100 GARDEN RD
Practice Address - Street 2:A - 207
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5366
Practice Address - Country:US
Practice Address - Phone:831-647-8490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22287103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA131910Medicare PIN