=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053121731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEYOND WORDS GRIEF LOSS AND TRAUMA THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2025
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3820 LONDON RD APT 112
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55804-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-226-8673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3820 LONDON RD APT 112
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55804-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-226-8673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | PEGGY ELIZABETH ROMERO
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 218-226-8673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------