Provider Demographics
NPI:1982093985
Name:DR WELLSPRING AZ
Entity Type:Organization
Organization Name:DR WELLSPRING AZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-868-1607
Mailing Address - Street 1:20 E UNIVERSITY DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5617
Mailing Address - Country:US
Mailing Address - Phone:480-303-0844
Mailing Address - Fax:480-303-0848
Practice Address - Street 1:20 E UNIVERSITY DR
Practice Address - Street 2:SUITE 301
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5617
Practice Address - Country:US
Practice Address - Phone:480-303-0844
Practice Address - Fax:480-303-0848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty