Healthcare Provider Details

I. General information

NPI: 1245051986
Provider Name (Legal Business Name): BE WELL THERAPY & CONSULTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MIDDLE RD STE 205
BETTENDORF IA
52722-3286
US

IV. Provider business mailing address

2550 MIDDLE RD STE 205
BETTENDORF IA
52722-3286
US

V. Phone/Fax

Practice location:
  • Phone: 563-503-6756
  • Fax:
Mailing address:
  • Phone: 563-503-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TARA LAFOLLETTE
Title or Position: CREDENTIALING REP
Credential:
Phone: 309-883-0908