Healthcare Provider Details

I. General information

NPI: 1073219705
Provider Name (Legal Business Name): JULIETA CAROLINA BEUSCHLEIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 E MAIN ST STE 185
SAINT CHARLES IL
60174-2423
US

IV. Provider business mailing address

1347 WINDGATE CT
BARTLETT IL
60103-1848
US

V. Phone/Fax

Practice location:
  • Phone: 630-549-6245
  • Fax:
Mailing address:
  • Phone: 773-206-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.009198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: