Provider Demographics
NPI:1962424887
Name:WELLSPRING COUNSELING
Entity type:Organization
Organization Name:WELLSPRING COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BONEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:616-460-3341
Mailing Address - Street 1:1345 MONROE AVE NW
Mailing Address - Street 2:SUITE 254
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4671
Mailing Address - Country:US
Mailing Address - Phone:616-460-3341
Mailing Address - Fax:616-874-9197
Practice Address - Street 1:1345 MONROE AVE NW
Practice Address - Street 2:SUITE 254
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4671
Practice Address - Country:US
Practice Address - Phone:616-460-3341
Practice Address - Fax:616-874-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable