Provider Demographics
NPI:1922780204
Name:BEWELL MENTAL HEALTH COUNSELING, PLLC
Entity Type:Organization
Organization Name:BEWELL MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOESBURG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:518-288-7557
Mailing Address - Street 1:855 ROUTE 146 STE 109
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3890
Mailing Address - Country:US
Mailing Address - Phone:518-288-7557
Mailing Address - Fax:518-704-4744
Practice Address - Street 1:855 ROUTE 146 STE 109
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3890
Practice Address - Country:US
Practice Address - Phone:518-288-7557
Practice Address - Fax:518-704-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty