Provider Demographics
NPI:1689455917
Name:WELLSPRING COUNSELING LLC
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-693-1891
Mailing Address - Street 1:283 US HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1432
Mailing Address - Country:US
Mailing Address - Phone:417-693-1891
Mailing Address - Fax:
Practice Address - Street 1:283 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1432
Practice Address - Country:US
Practice Address - Phone:417-693-1891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty