Provider Demographics
NPI:1922112077
Name:WELL-SPRING PSYCHIATRY, P.C.
Entity Type:Organization
Organization Name:WELL-SPRING PSYCHIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:CONLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:231-922-9625
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:LAKE ANN
Mailing Address - State:MI
Mailing Address - Zip Code:49650-0107
Mailing Address - Country:US
Mailing Address - Phone:231-922-9625
Mailing Address - Fax:231-929-5594
Practice Address - Street 1:1421 WAYNE ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1432
Practice Address - Country:US
Practice Address - Phone:231-922-9625
Practice Address - Fax:231-929-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4275243Medicaid
MIP00075183OtherRR MEDICARE
MIG48037Medicare UPIN
MI4275243Medicaid