Provider Demographics
NPI: | 1851501530 |
---|---|
Name: | WELLSPRING MULTIDISCIPLINARY HEALTH AND EDUCATION PROJECT INC |
Entity Type: | Organization |
Organization Name: | WELLSPRING MULTIDISCIPLINARY HEALTH AND EDUCATION PROJECT INC |
Other - Org Name: | WELLSPRING MENTAL HEALTH AND WELLNESS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARGARET |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | MCGUIRE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 802-472-6694 |
Mailing Address - Street 1: | PO BOX 147 |
Mailing Address - Street 2: | 39 CHURCH ST |
Mailing Address - City: | HARDWICK |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05843-0147 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 802-472-6694 |
Mailing Address - Fax: | 802-472-6694 |
Practice Address - Street 1: | 39 CHURCH ST. |
Practice Address - Street 2: | |
Practice Address - City: | HARDWICK |
Practice Address - State: | VT |
Practice Address - Zip Code: | 05843-0147 |
Practice Address - Country: | US |
Practice Address - Phone: | 802-472-6694 |
Practice Address - Fax: | 802-472-6694 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-23 |
Last Update Date: | 2013-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VT | VT 509 | 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TF0200X, 103TH0100X, 103TM1800X, 103TP2701X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Single Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Single Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Single Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Single Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Single Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Single Specialty |
No | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service | Group - Single Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Single Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VT | 1008971 | Medicaid | |
VT | VN3705 | Medicare PIN |