Healthcare Provider Details

I. General information

NPI: 1992406847
Provider Name (Legal Business Name): BE WELL AND BLOOM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E PUGH DR STE 15
TERRE HAUTE IN
47802-3938
US

IV. Provider business mailing address

476 E 7TH ST
CLINTON IN
47842-7069
US

V. Phone/Fax

Practice location:
  • Phone: 812-201-6299
  • Fax: 812-892-2820
Mailing address:
  • Phone: 812-201-6299
  • Fax: 812-892-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLAND WHEAT
Title or Position: OWNER
Credential: LMFT
Phone: 812-201-6299