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General NPI Number Information
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NPI Number | 1235664368
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Entity Type | Organization
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Legal Business Name | BEACH STONE COUNSELING
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 2641 E ATLANTIC BLVD STE 308
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4979
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Country | US
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Telephone | 754-300-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 2641 E ATLANTIC BLVD STE 308
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4979
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Country | US
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Telephone | 754-300-6127
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. MATHEW JEAN
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Credential | LMFT
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Telephone | 305-522-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 17-00092519
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License Number State | FL
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