Living Well Mental Health Clinic LLC
Organization Active NPI Clinical Psychologist · Owen, WI
NPI 1013413657 · NPPES record last updated Aug 16, 2024
Key facts
- NPI
- 1013413657
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- Legal business name
- LIVING WELL MENTAL HEALTH CLINIC LLC
- Practice address
- 112 N Central Ave
Owen, WI 54460 - Phone
- (715) 313-4748
- Fax
- (715) 229-0331
- NPI assigned
- Apr 3, 2018
- Organization subpart
- No
Authorized official
- Name
- Becca Greub
- Title
- Clinical Psychologist
- Phone
- (715) 313-4748
Practitioners 3
-
Becca Greub, PH.D
-
Mariah Smugala, MS, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180803000005 | WI | Part B Supplier - Clinic/Group Practice | 0446515092 |
Receives reassigned benefits from 1 practitioner Practice locations: Owen, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | Yes |
Addresses
Primary practice location
112 N Central Ave
Owen, WI 54460
Mailing address
PO Box 65
Owen, WI 54460-0065
Phone (715) 229-0330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548793235 | Medicaid | WI | |
| 1720477182 | Medicaid | WI | |
| K400340967 | Medicaid | WI | |
| 1184002560 | Medicaid | WI |
Other providers in Owen, WI
- Stacey L Gusman
- Raeann Henke
- Marta Miree Humblet
- Koplitz Mental Health Counseling LLC
- Sarah Beth Kranz
- Whitney Miller
- Alisha Marley Natzke
- Jaclene Elizabeth Newell
- Daniel Kenneth Nicholson
- Heather Ann Olejnichak
All providers in Owen, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.