Healthcare Provider Details

I. General information

NPI: 1215294301
Provider Name (Legal Business Name): NANCY J. BEACH LPC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S 8TH ST STE 206
COLORADO SPRINGS CO
80905
US

IV. Provider business mailing address

1355 S 8TH ST STE 206
COLORADO SPRINGS CO
80905-7022
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-7194
  • Fax:
Mailing address:
  • Phone: 719-358-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberRN-117289
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-6034
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: