Healthcare Provider Details

I. General information

NPI: 1306780440
Provider Name (Legal Business Name): BE WELL COLLABORATIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 PARK STREET RD
MULKEYTOWN IL
62865
US

IV. Provider business mailing address

1163 PARK STREET RD
MULKEYTOWN IL
62865
US

V. Phone/Fax

Practice location:
  • Phone: 618-816-5032
  • Fax:
Mailing address:
  • Phone: 618-816-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH L HARBISON
Title or Position: MANAGING MEMBER
Credential: FNP-BC, PMHNP-BC
Phone: 618-318-2472