Healthcare Provider Details

I. General information

NPI: 1235768946
Provider Name (Legal Business Name): ALIZA BEAULIEU LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 RENAISSANCE WAY
BOYNTON BEACH FL
33426-8228
US

IV. Provider business mailing address

2410 RENAISSANCE WAY
BOYNTON BEACH FL
33426-8228
US

V. Phone/Fax

Practice location:
  • Phone: 561-319-2114
  • Fax:
Mailing address:
  • Phone: 561-319-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: