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General NPI Number Information
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NPI Number | 1063178069
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Entity Type | Organization
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Legal Business Name | BE WELLNESS, LLC
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 64 E BROADWAY RD STE 280
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City | TEMPE
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State | AZ
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Zip | 85282-1353
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Country | US
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Telephone | 773-587-8240
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Fax | 773-526-7634
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Provider Business Mailing Address
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Address Line | 9449 S KEDZIE AVE # 533
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2325
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Country | US
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Telephone | 177-358-7824
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THERESA DENISE MOORE
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Credential | ED.D, LCPC
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Telephone | 773-587-8240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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