Provider Demographics
NPI:1992406847
Name:BE WELL AND BLOOM, LLC
Entity type:Organization
Organization Name:BE WELL AND BLOOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEAT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:812-201-6299
Mailing Address - Street 1:476 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-7069
Mailing Address - Country:US
Mailing Address - Phone:812-201-6299
Mailing Address - Fax:812-892-2820
Practice Address - Street 1:1400 E PUGH DR STE 15
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-3938
Practice Address - Country:US
Practice Address - Phone:812-201-6299
Practice Address - Fax:812-892-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health