NPIMap

Organization Active NPI

Wellspring Psychology PC

  • Clinical Psychologist
  • Los Gatos, CA
National Provider Identifier
1841655545
Registry record updated Oct 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY25909 Issued in CA
Legal business name
WELLSPRING PSYCHOLOGY PC
Practice address
475 Alberto Way Ste 180
Los Gatos, CA 95032-5481
Phone
(408) 357-4102
Fax
(408) 550-1879
NPI assigned
Dec 22, 2015
Last updated
Oct 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2021

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

Authorized official

Name
Dr. Richard Joshua Maddox, PH.D.NPI 1073847752
Title
President
Phone
(408) 357-4102

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
Clinical Psychologist 103TC0700X PSY25909 CA Primary

Addresses

Primary practice location

475 Alberto Way Ste 180
Los Gatos, CA 95032-5481

Mailing address

475 Alberto Way Ste 180
Los Gatos, CA 95032-5481
Phone (408) 357-4102

Other names 1

  • Wellspring Psychology Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160201002366 CA Part B Supplier - Clinic/Group Practice 4385948041 Receives reassigned benefits from 5 practitioners
Practice locations: Los Gatos, CA

National Provider Directory

National Provider Directory
Tax ID family
Wellspring Psychology2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

409 Alberto Way
Ste 5
Los Gatos, CA 95032
Phone (408) 357-4102

475 Alberto Way
Ste 180
Los Gatos, CA 95032
Phone (408) 357-4102

Practitioners & affiliated clinicians

Practitioners 8

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": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1841655545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 ALBERTO WAY STE 180",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950325481",
            "telephone_number": "408-357-4102",
            "fax_number": "408-550-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 ALBERTO WAY STE 180",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950325481",
            "telephone_number": "408-357-4102",
            "fax_number": "408-550-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING PSYCHOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-22",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "408-357-4102",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY25909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellspring Psychology",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Wellspring Psychology",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.