Provider Demographics
NPI:1730837857
Name:WELLSPRING COUNSELING LLC
Entity type:Organization
Organization Name:WELLSPRING COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:614-538-0353
Mailing Address - Street 1:1335 DUBLIN RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7007
Mailing Address - Country:US
Mailing Address - Phone:614-226-6493
Mailing Address - Fax:
Practice Address - Street 1:1335 DUBLIN RD STE 100A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7007
Practice Address - Country:US
Practice Address - Phone:614-226-6493
Practice Address - Fax:614-429-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty