Provider Demographics
NPI:1023468576
Name:WELLSPRINGS OF HEALING LLC
Entity type:Organization
Organization Name:WELLSPRINGS OF HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:303-669-2982
Mailing Address - Street 1:400 E SIMPSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2359
Mailing Address - Country:US
Mailing Address - Phone:303-669-2982
Mailing Address - Fax:
Practice Address - Street 1:400 E SIMPSON ST STE 105
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2359
Practice Address - Country:US
Practice Address - Phone:303-669-2982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53381785Medicaid