Provider Demographics
NPI:1679023576
Name:WELLSPRING COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING & CONSULTING
Other - Org Name:WELLSPRING COUNSELING AND CONSULTING, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:715-514-2535
Mailing Address - Street 1:1738 BRACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4626
Mailing Address - Country:US
Mailing Address - Phone:715-864-6386
Mailing Address - Fax:
Practice Address - Street 1:1738 BRACKETT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4626
Practice Address - Country:US
Practice Address - Phone:715-864-6386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4108-125101YP2500X
WI7633-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty