Healthcare Provider Details

I. General information

NPI: 1750998043
Provider Name (Legal Business Name): DEBORAH KOONS-BEAUCHAMP LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S MAIN ST
ALGONQUIN IL
60102-2641
US

IV. Provider business mailing address

302 S MAIN ST
ALGONQUIN IL
60102-2641
US

V. Phone/Fax

Practice location:
  • Phone: 319-431-0087
  • Fax:
Mailing address:
  • Phone: 319-431-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007407
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.001699
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: