Healthcare Provider Details

I. General information

NPI: 1851143648
Provider Name (Legal Business Name): KARUNA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 DAKOTA DR APT 206
JUPITER FL
33458-8494
US

IV. Provider business mailing address

1066 DAKOTA DR APT 206
JUPITER FL
33458-8494
US

V. Phone/Fax

Practice location:
  • Phone: 561-402-6786
  • Fax: 561-658-0738
Mailing address:
  • Phone: 561-402-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE WESLEY BEAUCHAMP
Title or Position: OWNER
Credential: LMHC
Phone: 561-402-6786