| Well-spring Psychiatry, P.c. | |
|
1421 Wayne St Traverse City MI 49684-1432 | |
| (231) 922-9625 | |
| (231) 929-5594 |
| Full Name | Well-spring Psychiatry, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1421 Wayne St, Traverse City, Michigan |
| Authorized Official Name and Position | Marilyn Eileen Conlon (PRESIDENT) |
| Authorized Official Contact | 2319229625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Well-spring Psychiatry, P.c. Po Box 107 Lake Ann MI 49650-0107 Ph: (231) 922-9625 | Well-spring Psychiatry, P.c. 1421 Wayne St Traverse City MI 49684-1432 Ph: (231) 922-9625 |
| NPI Number | 1922112077 |
|---|---|
| Provider Enumeration Date | 08/18/2006 |
| Last Update Date | 04/18/2008 |
| Medicare PECOS PAC ID | 4486549961 |
|---|---|
| Medicare Enrollment ID | O20040216000660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922112077 | NPI | - | NPPES |
| 4275243 | Medicaid | MI | |
| P00075183 | Other | MI | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Marilyn E Conlon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548373186 PECOS PAC ID: 2961316401 Enrollment ID: I20031118000637 |
| Provider Name | Alicia Kay Williamson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932819778 PECOS PAC ID: 5395103899 Enrollment ID: I20230615000601 |
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