Provider Demographics
NPI:1720502354
Name:WELLSPRING COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:WELLSPRING COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-908-6320
Mailing Address - Street 1:8358 S SLIDE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7193
Mailing Address - Country:US
Mailing Address - Phone:208-757-9957
Mailing Address - Fax:
Practice Address - Street 1:2589 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2325
Practice Address - Country:US
Practice Address - Phone:208-908-6320
Practice Address - Fax:208-908-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0056-0107189Medicaid