Healthcare Provider Details

I. General information

NPI: 1083529390
Provider Name (Legal Business Name): BEACH THERAPY & WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 SAINT LUKES DR
MONTGOMERY AL
36117-7105
US

IV. Provider business mailing address

495 SAINT LUKES DR
MONTGOMERY AL
36117-7105
US

V. Phone/Fax

Practice location:
  • Phone: 334-500-0693
  • Fax:
Mailing address:
  • Phone: 334-500-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SONYA R BEACH
Title or Position: PARTNER
Credential: LPC, RN
Phone: 334-500-0693