Healthcare Provider Details

I. General information

NPI: 1922819713
Provider Name (Legal Business Name): BLUE FIELDS MENTAL HEALTH & WELLNESS, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E MAIN ST
FROSTBURG MD
21532-1336
US

IV. Provider business mailing address

133 E MAIN ST
FROSTBURG MD
21532-1336
US

V. Phone/Fax

Practice location:
  • Phone: 301-687-2555
  • Fax: 463-300-5650
Mailing address:
  • Phone: 301-687-2555
  • Fax: 463-300-5650

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 Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JEANETTE BEDAL
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: APRN, PMHNP
Phone: 301-687-2555