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General NPI Number Information
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NPI Number | 1689433997
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Entity Type | Organization
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Legal Business Name | BEYOND WELLNESS PLLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 400 RENAISSANCE CTR STE 2600
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City | DETROIT
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State | MI
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Zip | 48243-1599
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Country | US
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Telephone | 702-728-0528
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30085
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City | LAS VEGAS
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State | NV
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Zip | 89173-0085
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISA ANDERSON
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Credential |
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Telephone | 855-380-6136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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