1447623046 NPI number — WELLSPRINGS PSYCHIATRY AND COUNSELING CENTER

Table of content: (NPI 1447623046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447623046 NPI number — WELLSPRINGS PSYCHIATRY AND COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSPRINGS PSYCHIATRY AND COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICHARD COLLETTI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447623046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 HOLIDAY COURT
Provider Second Line Business Mailing Address:
D-9
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-636-1188
Provider Business Mailing Address Fax Number:
888-381-3549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 HOLIDAY COURT
Provider Second Line Business Practice Location Address:
D-9
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-636-1188
Provider Business Practice Location Address Fax Number:
888-381-3549
Provider Enumeration Date:
11/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COLLETTI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-636-1188

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  41367 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103I261305 . This is a "PTAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1504192 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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