Provider Demographics
NPI:1508336223
Name:WELL PLLC
Entity Type:Organization
Organization Name:WELL PLLC
Other - Org Name:WELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/ CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-999-9660
Mailing Address - Street 1:801 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3106
Mailing Address - Country:US
Mailing Address - Phone:218-999-9660
Mailing Address - Fax:218-999-7560
Practice Address - Street 1:801 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3106
Practice Address - Country:US
Practice Address - Phone:218-398-0742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty