Provider Demographics
NPI:1407208937
Name:WELLSPRING THERAPY PLLC
Entity Type:Organization
Organization Name:WELLSPRING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:EITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-643-3987
Mailing Address - Street 1:42815 GARFIELD RD
Mailing Address - Street 2:203
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1143
Mailing Address - Country:US
Mailing Address - Phone:810-643-3987
Mailing Address - Fax:
Practice Address - Street 1:42815 GARFIELD RD
Practice Address - Street 2:203
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1143
Practice Address - Country:US
Practice Address - Phone:810-643-3987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty