| Wellspring Mental Health | |
|
5400 Phoenix Ave Ne Albuquerque NM 87110-3144 | |
| (505) 331-7815 | |
| Not Available |
| Full Name | Wellspring Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 5400 Phoenix Ave Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Mary Camille Cunningham (SOLE MBR) |
| Authorized Official Contact | 5053317815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Mental Health 5400 Phoenix Ave Ne Albuquerque NM 87110-3144 Ph: (505) 331-7815 | Wellspring Mental Health 5400 Phoenix Ave Ne Albuquerque NM 87110-3144 Ph: (505) 331-7815 |
| NPI Number | 1114483096 |
|---|---|
| Provider Enumeration Date | 02/14/2019 |
| Last Update Date | 02/14/2019 |
| Medicare PECOS PAC ID | 0244689065 |
|---|---|
| Medicare Enrollment ID | O20231205003315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114483096 | NPI | - | NPPES |
| 40870502 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary Camille Cunningham |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1154452704 PECOS PAC ID: 5890144620 Enrollment ID: I20231205003849 |
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