| Wellspring | |
|
101 N Fountain Ave Springfield OH 45502-1118 | |
| (937) 325-5564 | |
| (937) 325-5564 |
| Full Name | Wellspring |
|---|---|
| Speciality | Counselor |
| Location | 101 N Fountain Ave, Springfield, Ohio |
| Authorized Official Name and Position | Tiffany Nelson (OFFICE MANAGER) |
| Authorized Official Contact | 9373255564 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring 101 N Fountain Ave Springfield OH 45502-1118 Ph: (937) 325-5564 | Wellspring 101 N Fountain Ave Springfield OH 45502-1118 Ph: (937) 325-5564 |
| NPI Number | 1003851411 |
|---|---|
| Provider Enumeration Date | 06/19/2006 |
| Last Update Date | 12/16/2024 |
| Certification Date | 12/16/2024 |
| Medicare PECOS PAC ID | 5092748798 |
|---|---|
| Medicare Enrollment ID | O20250925000883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003851411 | NPI | - | NPPES |
| 10501 | Medicaid | OH |
| Provider Name | Tracey Stute |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447372602 PECOS PAC ID: 2062541287 Enrollment ID: I20100526001085 |
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