NPIMap

Organization Active NPI

Lifewell Behavioral Wellness

  • Community/Behavioral Health Agency
  • Phoenix, AZ
National Provider Identifier
1417050337
Registry record updated Mar 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIFEWELL BEHAVIORAL WELLNESS
Practice address
202 E Earll Dr
Suite 200
Phoenix, AZ 85012-2634
Phone
(602) 808-2800
Fax
(602) 808-2799
NPI assigned
Sep 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas K McKelvey
Title
Chief Executive Officer
Phone
(602) 599-5410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

202 E Earll Dr
Suite 200
Phoenix, AZ 85012-2634

Mailing address

202 E Earll Dr
Suite 200
Phoenix, AZ 85012-2634
Phone (602) 808-2800

Other identifiers 1

IdentifierTypeStateIssuer
Z102186OtherAZMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050412001535 AZ Part B Supplier - Clinic/Group Practice 4981641818 Receives reassigned benefits from 55 practitioners
Practice locations: Mesa, AZ; Phoenix, AZ

National Provider Directory

National Provider Directory
Tax ID family
Lifewell19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

6915 E Main St
Ste 200
Mesa, AZ 85207

4201 N 16th St
Ste 220
Phoenix, AZ 85016
Phone (602) 553-7300

40 E Mitchell Dr
Ste 200
Phoenix, AZ 85012
Phone (602) 995-7474

10844 N 23rd Ave
Ste 100
Phoenix, AZ 85029
Phone (602) 208-2800

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489708800000",
    "number": "1417050337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122634",
            "telephone_number": "602-808-2800",
            "fax_number": "602-808-2799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E EARLL DR",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122634",
            "telephone_number": "602-808-2800",
            "fax_number": "602-808-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWELL BEHAVIORAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2017-03-17",
        "status": "A",
        "authorized_official_last_name": "MCKELVEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-599-5410",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z102186",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.