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General NPI Number Information
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NPI Number | 1194803734
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Entity Type | Organization
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Legal Business Name | BEACON CLINIC, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3821 TAMIAMI TRL # D
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8377
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Country | US
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Telephone | 941-629-7855
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Fax | 941-629-9589
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Provider Business Mailing Address
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Address Line | 3821 TAMIAMI TRL # D
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8377
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Country | US
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Telephone | 941-629-7855
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Fax | 941-629-9589
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NOEL E HOLDSWORTH I
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Credential | ARNP
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Telephone | 941-629-7855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | NP2596452
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License Number State | FL
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