Provider Demographics
NPI:1336722792
Name:WELLSPRING COUNSELING & CONSULTATION
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING & CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAFFNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBLER-HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LSCSW, LCAC
Authorized Official - Phone:254-291-4183
Mailing Address - Street 1:3940 GOLDEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-1488
Mailing Address - Country:US
Mailing Address - Phone:254-291-4183
Mailing Address - Fax:
Practice Address - Street 1:1623 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4148
Practice Address - Country:US
Practice Address - Phone:785-380-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty