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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