Provider Demographics
NPI:1861013765
Name:WELLSPRING WOMEN'S COUNSELING PLLC
Entity Type:Organization
Organization Name:WELLSPRING WOMEN'S COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:SUZANNE DENISON
Authorized Official - Last Name:GETCHIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:952-497-0195
Mailing Address - Street 1:8725 COLUMBINE ROAD
Mailing Address - Street 2:#44122
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-479-0195
Mailing Address - Fax:
Practice Address - Street 1:8688 SHILOH COURT
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347
Practice Address - Country:US
Practice Address - Phone:952-479-0195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty