Provider Demographics
NPI:1508245390
Name:WELLSPRING COUNSELING CENTER
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-363-4973
Mailing Address - Street 1:516 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2083
Mailing Address - Country:US
Mailing Address - Phone:717-363-4973
Mailing Address - Fax:717-363-4973
Practice Address - Street 1:516 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2083
Practice Address - Country:US
Practice Address - Phone:717-363-4973
Practice Address - Fax:717-363-4973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC3114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty