Provider Demographics
NPI:1417218025
Name:WELLSPRING FAMILY SERVICES
Entity Type:Organization
Organization Name:WELLSPRING FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURR-CHELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-902-4227
Mailing Address - Street 1:1900 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4606
Mailing Address - Country:US
Mailing Address - Phone:206-826-3040
Mailing Address - Fax:866-451-0126
Practice Address - Street 1:1900 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-4606
Practice Address - Country:US
Practice Address - Phone:206-826-3040
Practice Address - Fax:866-451-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG 60226732251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management