Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS K MCKELVEY (CHIEF EXECUTIVE OFFICER)
(602) 599-5410
Entity
Organization
Contact information
Practice address
202 E EARLL DR, SUITE 200, PHOENIX, AZ 85012-2634
(602) 808-2800
(602) 808-2799
Mailing address
202 E EARLL DR, SUITE 200, PHOENIX, AZ 85012-2634
(602) 808-2800
(602) 808-2799
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z102186
MEDICARE PTAN
AZ
Enumeration date
09/06/2006
Last updated
03/17/2017
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