Healthcare Provider Details

I. General information

NPI: 1073110383
Provider Name (Legal Business Name): BEACON WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 STATE ST STE 5
BISMARCK ND
58503-0623
US

IV. Provider business mailing address

4205 STATE ST STE 5
BISMARCK ND
58503-0623
US

V. Phone/Fax

Practice location:
  • Phone: 701-214-5530
  • Fax: 701-712-5587
Mailing address:
  • Phone: 701-934-4695
  • Fax: 701-248-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LORY BETH HELLMAN
Title or Position: MEMBER
Credential: LPCC, CCMHC
Phone: 701-499-3667