Provider Demographics
NPI:1558847384
Name:WELLSPRING THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:WELLSPRING THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-314-0152
Mailing Address - Street 1:725 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5005
Mailing Address - Country:US
Mailing Address - Phone:406-314-0152
Mailing Address - Fax:
Practice Address - Street 1:725 6TH AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5005
Practice Address - Country:US
Practice Address - Phone:406-314-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT113841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty