Provider Demographics
NPI:1609603471
Name:BE WELL PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:BE WELL PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BEE
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG-VANG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:612-234-1558
Mailing Address - Street 1:7581 SPRINGBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1682
Mailing Address - Country:US
Mailing Address - Phone:715-379-1695
Mailing Address - Fax:
Practice Address - Street 1:2165 WOODLANE DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3055
Practice Address - Country:US
Practice Address - Phone:612-234-1558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health