Provider Demographics
NPI:1669693065
Name:WELLSPRING CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:WELLSPRING CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-604-5622
Mailing Address - Street 1:9 THE PINES CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6199
Mailing Address - Country:US
Mailing Address - Phone:314-878-5425
Mailing Address - Fax:314-878-5632
Practice Address - Street 1:9 THE PINES CT
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6199
Practice Address - Country:US
Practice Address - Phone:314-878-5425
Practice Address - Fax:314-878-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YA0400X, 101YM0800X, 101YP1600X, 101YP2500X, 106H00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty