# WELLSPRING LIFE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518661305
- **Authorized official:** MRS. TAMIKA MOORE LISW-S (CLINICAL DIRECTOR)
- **Authorized official phone:** (216) 714-2151

## Contact information

- **Practice address:** 20150 LAKE SHORE BLVD, EUCLID, OH 44123-1839
- **Practice address phone:** (216) 714-2151
- **Mailing address:** 20150 LAKE SHORE BLVD, EUCLID, OH 44123-1839
- **Mailing address phone:** (216) 714-2151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/28/2023
- **Last updated:** 03/28/2023