Provider Demographics
NPI:1083140057
Name:BE WELL COUNSELING LLC
Entity Type:Organization
Organization Name:BE WELL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RABER BERGEON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC
Authorized Official - Phone:715-853-8953
Mailing Address - Street 1:N6981 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-4222
Mailing Address - Country:US
Mailing Address - Phone:715-853-8953
Mailing Address - Fax:715-201-0395
Practice Address - Street 1:420 E GREEN BAY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2549
Practice Address - Country:US
Practice Address - Phone:715-853-8953
Practice Address - Fax:715-201-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75391231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821136540Medicaid