NPIMap

Organization Active NPI

Lifewell Behavioral Wellness

  • Community/Behavioral Health Agency
  • Mesa, AZ
National Provider Identifier
1720330194
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
OTC6851 Issued in AZ
Legal business name
LIFEWELL BEHAVIORAL WELLNESS
Practice address
6915 E. Main Street
Mesa, AZ 85207-8201
Phone
(602) 808-2800
Fax
(602) 808-2799
NPI assigned
Oct 10, 2012
Last updated
Oct 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Authorized official

Name
Thomas K McKelvey, CEO
Title
Chief Executive Officer
Phone
(602) 599-5410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X OTC6851 AZ Primary

Addresses

Primary practice location

6915 E. Main Street
Mesa, AZ 85207-8201

Mailing address

202 E. Earll Drive
Suite 200
Phoenix, AZ 85012-2647
Phone (602) 808-2800

Other identifiers 2

IdentifierTypeStateIssuer
Z102186OtherAZMEDICARE PTAN
762746MedicaidAZ

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

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1720330194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E. EARLL DRIVE",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122647",
            "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": "6915 E. MAIN STREET",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852078201",
            "telephone_number": "602-808-2800",
            "fax_number": "602-808-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWELL BEHAVIORAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2016-10-27",
        "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_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC6851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z102186",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "762746",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.