Provider Demographics
NPI:1740973551
Name:BE WELL THERAPEUTIC CENTER LLC
Entity type:Organization
Organization Name:BE WELL THERAPEUTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/LCSW PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRINEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-830-8077
Mailing Address - Street 1:107 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:62353-1333
Mailing Address - Country:US
Mailing Address - Phone:217-830-8077
Mailing Address - Fax:217-773-1106
Practice Address - Street 1:107 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-1333
Practice Address - Country:US
Practice Address - Phone:217-830-8077
Practice Address - Fax:217-773-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical