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General NPI Number Information
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NPI Number | 1043584758
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Entity Type | Individual
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Provider Name | ELLY J BEACH LMP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 1339 COMMERCE AVE STE 315A
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City | LONGVIEW
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State | WA
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Zip | 98632-3729
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Country | US
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Telephone | 360-425-1826
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Fax |
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Provider Business Mailing Address
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Address Line | 1222 10TH AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3108
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Country | US
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Telephone | 360-846-3335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60266172
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License Number State | WA
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