Provider Demographics
NPI:1558686543
Name:WELLSPRING COUNSELING, INC.
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOVA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KREPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-573-7009
Mailing Address - Street 1:14401 OLD CUTLER RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1722
Mailing Address - Country:US
Mailing Address - Phone:786-573-7009
Mailing Address - Fax:
Practice Address - Street 1:14401 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1722
Practice Address - Country:US
Practice Address - Phone:786-573-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7867101YM0800X
FLIMH8335101YM0800X
FLIMH9122101YM0800X
FLMH11127101YM0800X
FLIMH9839101YM0800X
FLSW63271041C0700X
FLSW110901041C0700X
FLMT2736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty