Provider Demographics
NPI:1043964380
Name:BE WELL THERAPEUTICS
Entity Type:Organization
Organization Name:BE WELL THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:662-415-2553
Mailing Address - Street 1:1310 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3809
Mailing Address - Country:US
Mailing Address - Phone:662-415-2553
Mailing Address - Fax:
Practice Address - Street 1:1310 BRIDLE PATH
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3809
Practice Address - Country:US
Practice Address - Phone:662-415-2553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)