Provider Demographics
NPI:1790460616
Name:BWELL COUNSELING SERVICES
Entity Type:Organization
Organization Name:BWELL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, RPT
Authorized Official - Phone:815-715-5679
Mailing Address - Street 1:13824 W CHASE CT
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-9457
Mailing Address - Country:US
Mailing Address - Phone:815-715-5679
Mailing Address - Fax:
Practice Address - Street 1:18700 WOLF RD STE 209
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8699
Practice Address - Country:US
Practice Address - Phone:708-540-3951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty