Provider Demographics
NPI:1821033390
Name:WELLSPRING COUNSELING CENTER INC
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WESER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-916-0522
Mailing Address - Street 1:3284 HIGHLANDS RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-3549
Mailing Address - Country:US
Mailing Address - Phone:941-916-0522
Mailing Address - Fax:941-206-2201
Practice Address - Street 1:18245 PAULSON DR
Practice Address - Street 2:SUITE 111
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-1019
Practice Address - Country:US
Practice Address - Phone:941-916-0522
Practice Address - Fax:941-206-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00048691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL238461OtherCOM PSYCH PROVIDER ID
FL87726OtherUNITED BEH. HEALTH ID
FLZ8351OtherBCBS PROVIDER NUMBER
FL87726OtherUNITED BEH. HEALTH ID
FLZ8351OtherBCBS PROVIDER NUMBER