Provider Demographics
NPI:1700028503
Name:WELLSPRING COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTRATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-883-9400
Mailing Address - Street 1:4305 S GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9425
Mailing Address - Country:US
Mailing Address - Phone:262-554-7215
Mailing Address - Fax:
Practice Address - Street 1:4305 S GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9425
Practice Address - Country:US
Practice Address - Phone:262-554-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health