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General NPI Number Information
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NPI Number | 1457421323
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Entity Type | Individual
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Provider Name | GLENDA GAIL BEACH LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 3980 TAMPA RD SUITE 205
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City | OLDSMAR
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State | FL
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Zip | 34677-3223
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Country | US
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Telephone | 727-787-0646
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Fax | 813-814-4352
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Provider Business Mailing Address
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Address Line | 331 BAY ARBOR BLVD
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City | OLDSMAR
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State | FL
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Zip | 34677-4617
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Country | US
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Telephone | 727-787-0646
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Fax | 813-814-4352
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1714
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License Number State | FL
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