MEDICARE: BE WELL COLLABORATIVE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1306780440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BE WELL COLLABORATIVE PLLC

Provider Business Mailing Address
First Line	:	1163 PARK STREET RD
Second Line	:
City	:	MULKEYTOWN
State	:	IL
Zip	:	62865
Country	:	US
Telephone Number	:	618-816-5032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1163 PARK STREET RD
Second Line	:
City	:	MULKEYTOWN
State	:	IL
Zip	:	62865
Country	:	US
Telephone Number	:	618-816-5032
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ELIZABETH L HARBISON
Credential	:	FNP-BC, PMHNP-BC
Telephone Number	:	618-318-2472

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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