Organization
BE WELL PROVIDERS, LLC
Active
Other names
Behavioral Wellness Clinic, Louisville OCD Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN BRENT WALLEN J.D. (BUSINESS MANAGER)
(502) 319-3105
Entity
Organization
Contact information
Practice address
11824 RANSUM DR STE 100, LOUISVILLE, KY 40243-2802
(502) 338-0608
(502) 245-1888
Mailing address
2107 STRATHMOOR BLVD, LOUISVILLE, KY 40205-2529
(502) 319-3105
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/28/2017
Last updated
05/25/2021
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