Organization
WELL-SPRING PSYCHIATRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN EILEEN CONLON M.D., (PRESIDENT)
(231) 922-9625
Entity
Organization
Contact information
Practice address
1421 WAYNE ST, TRAVERSE CITY, MI 49684-1432
(231) 922-9625
(231) 929-5594
Mailing address
PO BOX 107, LAKE ANN, MI 49650-0107
(231) 922-9625
(231) 929-5594
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4275243
—
MI
01
—
P00075183
RR MEDICARE
MI
Enumeration date
08/18/2006
Last updated
04/18/2008
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