Provider Demographics
NPI:1689326837
Name:BEACON WELLNESS SOLUTIONS LLC
Entity Type:Organization
Organization Name:BEACON WELLNESS SOLUTIONS LLC
Other - Org Name:BEACON WELLNESS AND PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:231-881-8838
Mailing Address - Street 1:101 LEWIS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-881-8838
Mailing Address - Fax:
Practice Address - Street 1:101 LEWIS ST STE 2
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-881-8838
Practice Address - Fax:231-622-8037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACON WELLNESS SOLUTIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty