Provider Demographics
NPI:1790049716
Name:WELLSPRING HUMAN SERVICES
Entity Type:Organization
Organization Name:WELLSPRING HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-263-2872
Mailing Address - Street 1:1017 ROBERTSON ST
Mailing Address - Street 2:ATT. INNER HEALTH BLDG
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3926
Mailing Address - Country:US
Mailing Address - Phone:303-263-2872
Mailing Address - Fax:
Practice Address - Street 1:1017 ROBERTSON ST
Practice Address - Street 2:ATT. INNER HEALTH BLDG
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3926
Practice Address - Country:US
Practice Address - Phone:303-263-2872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO788251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health