1013100114 NPI number — WELLSPRING PSYCHOLOGICAL ASSOCIATES

Table of content: (NPI 1013100114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013100114 NPI number — WELLSPRING PSYCHOLOGICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSPRING PSYCHOLOGICAL ASSOCIATES
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:
Provider Other Organization Name Type Code:
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:
1013100114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 NW TARRANT AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
BURLESON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76028-3866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-448-2800
Provider Business Mailing Address Fax Number:
832-448-2801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 S OLD BETSY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76059-2426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-448-2800
Provider Business Practice Location Address Fax Number:
832-448-2801
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FEE
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-448-2800

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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