| Well | |
|
801 Ne 4th St Grand Rapids MN 55744-3106 | |
| (218) 398-0742 | |
| Not Available |
| Full Name | Well |
|---|---|
| Speciality | Counselor |
| Location | 801 Ne 4th St, Grand Rapids, Minnesota |
| Authorized Official Name and Position | James Dale Christian (THERAPIST/ CO-OWNER) |
| Authorized Official Contact | 2189999660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Well 801 Ne 4th St Grand Rapids MN 55744-3106 Ph: (218) 999-9660 | Well 801 Ne 4th St Grand Rapids MN 55744-3106 Ph: (218) 398-0742 |
| NPI Number | 1508336223 |
|---|---|
| Provider Enumeration Date | 11/26/2018 |
| Last Update Date | 06/01/2020 |
| Certification Date | 06/01/2020 |
| Medicare PECOS PAC ID | 6800132416 |
|---|---|
| Medicare Enrollment ID | O20190117002500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508336223 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Linh M Scally |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316225527 PECOS PAC ID: 2567762248 Enrollment ID: I20151202001000 |
| Provider Name | James Dale Christian |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548699986 PECOS PAC ID: 8527304138 Enrollment ID: I20240402001066 |
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