Provider Demographics
NPI:1568848919
Name:WELLSPRING BEHAVIOR CONSULTING, LLC
Entity Type:Organization
Organization Name:WELLSPRING BEHAVIOR CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-250-3263
Mailing Address - Street 1:5170 GOLDEN FOOTHILL PKWY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9608
Mailing Address - Country:US
Mailing Address - Phone:916-250-3263
Mailing Address - Fax:916-692-1460
Practice Address - Street 1:5170 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9608
Practice Address - Country:US
Practice Address - Phone:916-250-3263
Practice Address - Fax:916-692-1460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-08
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty