Provider Demographics
NPI:1619188794
Name:WELLSPRING COUNSELING LLC
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING LLC
Other - Org Name:WELLSPRING COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:614-538-0353
Mailing Address - Street 1:1335 DUBLIN ROAD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-538-0353
Mailing Address - Fax:614-429-3219
Practice Address - Street 1:1335 DUBLIN ROAD
Practice Address - Street 2:SUITE 100A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-538-0353
Practice Address - Fax:614-429-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty