Provider Demographics
NPI:1578289492
Name:WELLSPRING THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:WELLSPRING THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-945-1369
Mailing Address - Street 1:1800 PEMBROOK DR # 300-1272
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6928
Mailing Address - Country:US
Mailing Address - Phone:407-955-9774
Mailing Address - Fax:
Practice Address - Street 1:5931 BRICK CT STE 130
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9411
Practice Address - Country:US
Practice Address - Phone:407-955-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty