Provider Demographics
NPI:1396761821
Name:WELLSPRING COUNSELING SERVICES LLP
Entity type:Organization
Organization Name:WELLSPRING COUNSELING SERVICES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-341-5933
Mailing Address - Street 1:328 E WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3988
Mailing Address - Country:US
Mailing Address - Phone:319-341-5933
Mailing Address - Fax:319-341-5920
Practice Address - Street 1:328 E WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3988
Practice Address - Country:US
Practice Address - Phone:319-341-5933
Practice Address - Fax:319-341-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38482OtherBC/BS GROUP #
IAI15823Medicare ID - Type UnspecifiedGROUP NUMBER