Provider Demographics
NPI:1295308203
Name:WELLSTONE HEALING CENTER
Entity type:Organization
Organization Name:WELLSTONE HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-323-0161
Mailing Address - Street 1:936B 7TH ST # 152
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3002
Mailing Address - Country:US
Mailing Address - Phone:415-323-0161
Mailing Address - Fax:415-326-8085
Practice Address - Street 1:1801 BUSH ST STE 209
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5297
Practice Address - Country:US
Practice Address - Phone:415-323-0161
Practice Address - Fax:415-326-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty