Healthcare Provider Details

I. General information

NPI: 1902209588
Provider Name (Legal Business Name): PETE BELL, LCSW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 WITHINGTON ST
MEDFORD OR
97501-3368
US

IV. Provider business mailing address

1229 WITHINGTON ST
MEDFORD OR
97501-3368
US

V. Phone/Fax

Practice location:
  • Phone: 404-680-6662
  • Fax: 706-250-9945
Mailing address:
  • Phone: 404-680-6662
  • Fax: 706-250-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005070
License Number StateGA

VIII. Authorized Official

Name: MR. PETER BELL
Title or Position: OWNER AND CLINICIAN
Credential: LCSW
Phone: 404-680-6662