MEDICARE: MRS. BETH PATRICIA MCNALLY LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1062	MN
2	101YP2500X	Professional Counselor	1399	MN

General Provider Information

NPI Number	:	1285030940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH PATRICIA MCNALLY LPCC

Provider Business Mailing Address
First Line	:	970 RAYMOND AVE STE 102
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1164
Country	:	US
Telephone Number	:	612-387-3112
Fax Number	:	651-900-7595

Provider Business Practice Location Address
First Line	:	970 RAYMOND AVE STE 102
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1164
Country	:	US
Telephone Number	:	612-387-3112
Fax Number	:	651-900-7595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	07/21/2022

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