NPIMap

Organization Active NPI

Wellspring Renewal Center

  • Mental Health Counselor
  • Little Rock, AR
National Provider Identifier
1053833939
Registry record updated Jul 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
P1101005 Issued in AR
Legal business name
WELLSPRING RENEWAL CENTER
Practice address
101 N Woodrow St
Little Rock, AR 72205-4341
Phone
15012650046
NPI assigned
Jul 12, 2017
Last updated
Jul 12, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebecca Spooner, LPCNPI 1992844310
Title
Owner
Phone
(501) 265-0046

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X P1101005 AR Primary

Addresses

Primary practice location

101 N Woodrow St
Little Rock, AR 72205-4341

Mailing address

101 N Woodrow St
Little Rock, AR 72205-4341
Phone (501) 265-0046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240319002191 AR Part B Supplier - Clinic/Group Practice 1254778897 Receives reassigned benefits from 6 practitioners
Practice locations: Little Rock, AR

National Provider Directory

National Provider Directory

Locations

101 N Woodrow St
Little Rock, AR 72205
Phone (501) 265-0046

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1053833939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N WOODROW ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722054341",
            "telephone_number": "15012650046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N WOODROW ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722054341",
            "telephone_number": "15012650046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING RENEWAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "SPOONER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-265-0046",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "P1101005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.