| Wellspring Psychology Pc | |
|
475 Alberto Way Ste 180 Los Gatos CA 95032-5481 | |
| (408) 357-4102 | |
| (408) 550-1879 |
| Full Name | Wellspring Psychology Pc |
|---|---|
| Speciality | Psychologist |
| Location | 475 Alberto Way Ste 180, Los Gatos, California |
| Authorized Official Name and Position | Richard Joshua Maddox (PRESIDENT) |
| Authorized Official Contact | 4083574102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Psychology Pc 475 Alberto Way Ste 180 Los Gatos CA 95032-5481 Ph: (408) 357-4102 | Wellspring Psychology Pc 475 Alberto Way Ste 180 Los Gatos CA 95032-5481 Ph: (408) 357-4102 |
| NPI Number | 1841655545 |
|---|---|
| Provider Enumeration Date | 12/22/2015 |
| Last Update Date | 10/08/2021 |
| Certification Date | 10/08/2021 |
| Medicare PECOS PAC ID | 4385948041 |
|---|---|
| Medicare Enrollment ID | O20160201002366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841655545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY25909 (California) | Primary |
| Provider Name | Michelle S Wolf-bloom |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396884789 PECOS PAC ID: 1658521422 Enrollment ID: I20121101000557 |
| Provider Name | Richard J Maddox |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073847752 PECOS PAC ID: 8820219421 Enrollment ID: I20141111000783 |
| Provider Name | Matthew J Metzger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003048968 PECOS PAC ID: 6103047709 Enrollment ID: I20150108000604 |
| Provider Name | Joshua Christopher White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477853687 PECOS PAC ID: 8729356217 Enrollment ID: I20170626002165 |
| Provider Name | Max A Garlick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790834661 PECOS PAC ID: 8921341249 Enrollment ID: I20190529002839 |
| Provider Name | Michiko Akahori |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083861009 PECOS PAC ID: 9638567993 Enrollment ID: I20211019003341 |
| Provider Name | Miranda Pinckert |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689245821 PECOS PAC ID: 2567851892 Enrollment ID: I20211108001821 |
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