MEDICARE: SUSAN BECKMAN-MITCHELL LPC, MA

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	6401001487	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417190588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BECKMAN-MITCHELL LPC, MA

Provider Business Mailing Address
First Line	:	12899 W HERBISON RD
Second Line	:
City	:	EAGLE
State	:	MI
Zip	:	48822-9648
Country	:	US
Telephone Number	:	517-242-1762
Fax Number	:	517-247-2844

Provider Business Practice Location Address
First Line	:	12899 W HERBISON RD
Second Line	:
City	:	EAGLE
State	:	MI
Zip	:	48822-9648
Country	:	US
Telephone Number	:	517-242-1762
Fax Number	:	517-247-2844

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

Provider Enumeration Date	:	04/19/2009
Last Update Date	:	02/13/2024

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