Healthcare Provider Details

I. General information

NPI: 1972857563
Provider Name (Legal Business Name): BEACON OF HOPE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2012
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 GOFFE ST
SAINT CLAIR MI
48079-5111
US

IV. Provider business mailing address

1645 GOFFE ST
SAINT CLAIR MI
48079-5111
US

V. Phone/Fax

Practice location:
  • Phone: 810-289-2720
  • Fax: 810-857-6606
Mailing address:
  • Phone: 810-289-2720
  • Fax: 810-857-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. STACEY RENAE KRAUSE
Title or Position: OWNER/THERAPIST
Credential: LMSW
Phone: 810-289-2720