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General NPI Number Information
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NPI Number | 1992406847
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Entity Type | Organization
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Legal Business Name | BE WELL AND BLOOM, LLC
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 1400 E PUGH DR STE 15
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City | TERRE HAUTE
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State | IN
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Zip | 47802-3938
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Country | US
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Telephone | 812-201-6299
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Fax | 812-892-2820
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Provider Business Mailing Address
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Address Line | 476 E 7TH ST
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City | CLINTON
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State | IN
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Zip | 47842-7069
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Country | US
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Telephone | 812-201-6299
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Fax | 812-892-2820
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Authorized Official
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Title or Position | OWNER
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Name | ASHLAND WHEAT
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Credential | LMFT
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Telephone | 812-201-6299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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