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General NPI Number Information
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NPI Number | 1023829819
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Entity Type | Organization
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Legal Business Name | BEACONLIGHT COUNSELING LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 101 CARRIAGE WAY STE 200
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City | HURRICANE
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State | WV
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Zip | 25526-1530
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Country | US
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Telephone | 304-305-1309
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CARRIAGE WAY STE 200
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City | HURRICANE
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State | WV
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Zip | 25526-1530
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Country | US
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Telephone | 304-444-7315
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON PAUL WAGGONER
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Credential | PHD
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Telephone | 304-444-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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