Healthcare Provider Details

I. General information

NPI: 1457934903
Provider Name (Legal Business Name): BEACON HEALING & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 RIVER HIGHLANDS BLVD STE 8
COVINGTON LA
70433-8987
US

IV. Provider business mailing address

14707 PERKINS RD
BATON ROUGE LA
70810-2216
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-2942
  • Fax: 985-231-1373
Mailing address:
  • Phone: 225-810-4040
  • Fax: 225-810-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP SEAN WENDELL
Title or Position: CEO
Credential:
Phone: 225-810-4040