Provider Demographics
NPI:1356389282
Name:WELLSPRING HEALTHCARE ASSOCIATES, PA
Entity type:Organization
Organization Name:WELLSPRING HEALTHCARE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:479-986-0566
Mailing Address - Street 1:324 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6647
Mailing Address - Country:US
Mailing Address - Phone:479-986-0566
Mailing Address - Fax:479-986-0599
Practice Address - Street 1:324 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6647
Practice Address - Country:US
Practice Address - Phone:479-986-0566
Practice Address - Fax:479-986-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C317Medicare ID - Type Unspecified