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Organization
WELLSPRING COUNSELING CENTER OF GREATER LAFAYETTE, INC
Active
Organization
WELLSPRING COUNSELING CENTER OF GREATER LAFAYETTE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRANDON JOSHUA EZRA (TREASURER)
(888) 818-9915
Entity
Organization
Contact information
Practice address
2655 YEAGER RD, STE 102, WEST LAFAYETTE, IN 47906-1337
(765) 237-3326
Mailing address
2655 YEAGER RD, STE 102, WEST LAFAYETTE, IN 47906-1337
(765) 237-3326
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
02/02/2017
Last updated
02/02/2017
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