| Wellspring Renewal Center | |
|
101 N Woodrow St Little Rock AR 72205-4341 | |
| (150) 126-50046 | |
| Not Available |
| Full Name | Wellspring Renewal Center |
|---|---|
| Speciality | Counselor |
| Location | 101 N Woodrow St, Little Rock, Arkansas |
| Authorized Official Name and Position | Rebecca Spooner (OWNER) |
| Authorized Official Contact | 5012650046 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Renewal Center 101 N Woodrow St Little Rock AR 72205-4341 Ph: (150) 126-50046 | Wellspring Renewal Center 101 N Woodrow St Little Rock AR 72205-4341 Ph: (150) 126-50046 |
| NPI Number | 1053833939 |
|---|---|
| Provider Enumeration Date | 07/12/2017 |
| Last Update Date | 07/12/2017 |
| Medicare PECOS PAC ID | 1254778897 |
|---|---|
| Medicare Enrollment ID | O20240319002191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053833939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | P1101005 (Arkansas) | Primary |
| Provider Name | Leah Payne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407137029 PECOS PAC ID: 7810334471 Enrollment ID: I20240319002830 |
| Provider Name | Michelle Ainsworth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851420764 PECOS PAC ID: 3375980824 Enrollment ID: I20240320002273 |
| Provider Name | Audrene Janelle Ellis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366105207 PECOS PAC ID: 9537506951 Enrollment ID: I20240321001021 |
| Provider Name | April Leanne Mcspadden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487802005 PECOS PAC ID: 2668819780 Enrollment ID: I20240326000578 |
| Provider Name | Trevor Trietsch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568034668 PECOS PAC ID: 2163860883 Enrollment ID: I20240401001674 |
| Provider Name | Rebecca Spooner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992844310 PECOS PAC ID: 7517304157 Enrollment ID: I20240401003416 |
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