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General NPI Number Information
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NPI Number | 1811494503
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Entity Type | Organization
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Legal Business Name | BEAL WELLNESS LLC
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 1093 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-6740
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Country | US
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Telephone | 404-768-2218
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Fax |
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Provider Business Mailing Address
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Address Line | 1093 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-6740
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Country | US
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Telephone | 404-768-2218
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER FIELDS
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Credential |
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Telephone | 404-768-2218
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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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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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