Provider Demographics
NPI:1760853626
Name:WELLSPRING WELLNESS MANIFEST
Entity Type:Organization
Organization Name:WELLSPRING WELLNESS MANIFEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SPEEKS
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA; PRSS, IRSS
Authorized Official - Phone:210-607-7125
Mailing Address - Street 1:2313 LOCKHILL SELMA RD # 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3007
Mailing Address - Country:US
Mailing Address - Phone:210-607-7125
Mailing Address - Fax:210-582-2711
Practice Address - Street 1:5624 RANDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6116
Practice Address - Country:US
Practice Address - Phone:210-607-7125
Practice Address - Fax:210-582-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X
171M00000X, 174H00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty