Healthcare Provider Details

I. General information

NPI: 1609397793
Provider Name (Legal Business Name): BETH EGGLESTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

IV. Provider business mailing address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-2411
  • Fax: 907-352-3363
Mailing address:
  • Phone: 907-376-2411
  • Fax: 907-352-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number188207
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC8277
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: