Healthcare Provider Details

I. General information

NPI: 1003308032
Provider Name (Legal Business Name): BE WELL COUNSELING & CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W FRONT ST
GRAND LEDGE MI
48837-1019
US

IV. Provider business mailing address

405 W FRONT ST
GRAND LEDGE MI
48837-1019
US

V. Phone/Fax

Practice location:
  • Phone: 517-526-3787
  • Fax: 888-622-1865
Mailing address:
  • Phone: 517-526-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTY BLACKMER
Title or Position: OWNER
Credential: LPC
Phone: 517-526-3787