Organization
WELLSPRING CT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH BECKER MA, LADC, LPCC (OWNER)
(612) 325-8357
Entity
Organization
Contact information
Practice address
4048 LAKELAND AVE N, MINNEAPOLIS, MN 55422-2381
(612) 325-8357
Mailing address
4048 LAKELAND AVE N, MINNEAPOLIS, MN 55422-2381
(612) 325-8357
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
520
MN
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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