Provider Demographics
NPI:1912891433
Name:WELLSPACE LLC
Entity type:Organization
Organization Name:WELLSPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:208-918-2588
Mailing Address - Street 1:6568 S FEDERAL WAY STE 241
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9277
Mailing Address - Country:US
Mailing Address - Phone:208-918-2588
Mailing Address - Fax:
Practice Address - Street 1:1523 E BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5064
Practice Address - Country:US
Practice Address - Phone:208-918-2588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health