Provider Demographics
NPI:1548954910
Name:GEMSPRING THERAPY LLC
Entity type:Organization
Organization Name:GEMSPRING THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JASPER
Authorized Official - Middle Name:
Authorized Official - Last Name:WURSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCPC
Authorized Official - Phone:248-677-1502
Mailing Address - Street 1:949 W FARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3107
Mailing Address - Country:US
Mailing Address - Phone:248-677-1502
Mailing Address - Fax:313-789-1664
Practice Address - Street 1:1518 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3402
Practice Address - Country:US
Practice Address - Phone:248-677-1502
Practice Address - Fax:313-789-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty