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General NPI Number Information
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NPI Number | 1295544294
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Entity Type | Organization
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Legal Business Name | BEACHWALK COUNSELING LLC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 31119 BEACHWALK DR APT 406
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City | NOVI
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State | MI
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Zip | 48377-1444
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Country | US
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Telephone | 313-737-0164
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Fax |
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Provider Business Mailing Address
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Address Line | 221 W LAKE LANSING RD STE 200
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City | EAST LANSING
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State | MI
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Zip | 48823-8661
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Country | US
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Telephone | 313-737-0164
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN ENERSEN
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Credential |
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Telephone | 313-737-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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