Healthcare Provider Details

I. General information

NPI: 1134285935
Provider Name (Legal Business Name): STUART BEDDIE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 PARADISE RD
BETHEL ME
04217-3601
US

IV. Provider business mailing address

PO BOX 374
BETHEL ME
04217-0374
US

V. Phone/Fax

Practice location:
  • Phone: 207-749-5883
  • Fax:
Mailing address:
  • Phone: 207-749-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC2399
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: