Healthcare Provider Details

I. General information

NPI: 1043964380
Provider Name (Legal Business Name): BE WELL THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 BRIDLE PATH
CORINTH MS
38834-3809
US

IV. Provider business mailing address

1310 BRIDLE PATH
CORINTH MS
38834-3809
US

V. Phone/Fax

Practice location:
  • Phone: 662-415-2553
  • Fax:
Mailing address:
  • Phone: 662-415-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA C CLEARY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MS, LPC
Phone: 662-415-2553