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General NPI Number Information
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NPI Number | 1467540294
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Entity Type | Individual
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Provider Name | NICOLE M BEAGLE LBSW, LLP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 217 E SANILAC RD
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City | SANDUSKY
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State | MI
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Zip | 48471-1383
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Country | US
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Telephone | 810-648-4327
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Fax | 810-648-4338
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Provider Business Mailing Address
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Address Line | 177 S FULTON ST
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City | SANDUSKY
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State | MI
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Zip | 48471-1345
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Country | US
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Telephone | 810-648-9249
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802085142
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301013447
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License Number State | MI
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