Provider Demographics
NPI:1063178069
Name:BE WELLNESS, LLC
Entity type:Organization
Organization Name:BE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC
Authorized Official - Phone:773-587-8240
Mailing Address - Street 1:9449 S KEDZIE AVE # 533
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:177-358-7824
Mailing Address - Fax:
Practice Address - Street 1:64 E BROADWAY RD STE 280
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1353
Practice Address - Country:US
Practice Address - Phone:773-587-8240
Practice Address - Fax:773-526-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health