Healthcare Provider Details

I. General information

NPI: 1922780204
Provider Name (Legal Business Name): BEWELL MENTAL HEALTH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ROUTE 146 STE 109
CLIFTON PARK NY
12065-3890
US

IV. Provider business mailing address

855 ROUTE 146 STE 109
CLIFTON PARK NY
12065-3890
US

V. Phone/Fax

Practice location:
  • Phone: 518-288-7557
  • Fax: 518-704-4744
Mailing address:
  • Phone: 518-288-7557
  • Fax: 518-704-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DOESBURG
Title or Position: OWNER
Credential: LMHC
Phone: 518-288-7557