Healthcare Provider Details

I. General information

NPI: 1508720665
Provider Name (Legal Business Name): BECOMING WHOLE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N DIXIE WAY STE 205
SOUTH BEND IN
46637-3369
US

IV. Provider business mailing address

219 N DIXIE WAY STE 205
SOUTH BEND IN
46637-3369
US

V. Phone/Fax

Practice location:
  • Phone: 574-850-4344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: REGINA URIBE
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential:
Phone: 574-850-4344