Healthcare Provider Details

I. General information

NPI: 1669979480
Provider Name (Legal Business Name): BETH NORTH, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 CENTERVILLE RD
TALLAHASSEE FL
32308-4317
US

IV. Provider business mailing address

3408 WHIRL A WAY TRL
TALLAHASSEE FL
32309-1927
US

V. Phone/Fax

Practice location:
  • Phone: 303-519-9517
  • Fax:
Mailing address:
  • Phone: 303-519-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11034
License Number StateFL

VIII. Authorized Official

Name: MS. BETH NORTH
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 303-519-9517