Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS K MCKELVEY CEO (CHIEF EXECUTIVE OFFICER)
(602) 599-5410
Entity
Organization
Contact information
Practice address
6915 E. MAIN STREET, MESA, AZ 85207-8201
(602) 808-2800
(602) 808-2799
Mailing address
202 E. EARLL DRIVE, SUITE 200, PHOENIX, AZ 85012-2647
(602) 808-2800
(602) 808-2799
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
OTC6851
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
762746
—
AZ
01
—
Z102186
MEDICARE PTAN
AZ
Enumeration date
10/10/2012
Last updated
10/27/2016
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