Provider Demographics
NPI:1710730205
Name:BECOME WHOLE, LLC
Entity Type:Organization
Organization Name:BECOME WHOLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JAZZMIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MADDOX-COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:478-919-6711
Mailing Address - Street 1:8803 MESA VIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-2282
Mailing Address - Country:US
Mailing Address - Phone:478-919-6711
Mailing Address - Fax:
Practice Address - Street 1:8803 MESA VIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-2282
Practice Address - Country:US
Practice Address - Phone:803-273-5601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health