Healthcare Provider Details

I. General information

NPI: 1790211456
Provider Name (Legal Business Name): JANICE BEAUCHAMP LBSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 7TH AVE S SUITE 202
ESCANABA MI
49829-1176
US

IV. Provider business mailing address

97 S 4TH ST
ISHPEMING MI
49849-2168
US

V. Phone/Fax

Practice location:
  • Phone: 906-789-3528
  • Fax: 906-786-9801
Mailing address:
  • Phone: 906-789-3528
  • Fax: 906-786-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-01314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: