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General NPI Number Information
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NPI Number | 1790460616
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Entity Type | Organization
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Legal Business Name | BWELL COUNSELING SERVICES
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 18700 WOLF RD STE 209
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City | MOKENA
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State | IL
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Zip | 60448-8699
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Country | US
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Telephone | 708-540-3951
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Fax |
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Provider Business Mailing Address
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Address Line | 13824 W CHASE CT
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City | MANHATTAN
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State | IL
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Zip | 60442-9457
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Country | US
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Telephone | 815-715-5679
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Fax |
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Authorized Official
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Title or Position | CHILD COUNSELOR
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Name | KIMBER LUBERT
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Credential | LCPC, RPT
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Telephone | 815-715-5679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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