Healthcare Provider Details

I. General information

NPI: 1104004217
Provider Name (Legal Business Name): BEACH COUNSELING & TESTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17169 JAYS WAY
MILTON DE
19968-3413
US

IV. Provider business mailing address

17169 JAYS WAY
MILTON DE
19968-3413
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-2213
  • Fax: 302-703-2744
Mailing address:
  • Phone: 302-703-2213
  • Fax: 302-703-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC0000419
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPC0000419
License Number StateDE

VIII. Authorized Official

Name: LES A BINNIX
Title or Position: PRESIDENT
Credential: PLCMH
Phone: 302-703-2213