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General NPI Number Information
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NPI Number | 1497910343
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Entity Type | Individual
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Provider Name | MIMI BEAULIEU LPC, CCDP
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Gender | Female
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 195 S MAIN ST
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City | CHESHIRE
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State | CT
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Zip | 06410-3171
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Country | US
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Telephone | 203-298-8307
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Fax |
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Provider Business Mailing Address
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Address Line | 83 CHESTERFIELD RD
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City | EAST LYME
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State | CT
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Zip | 06333-1202
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Country | US
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Telephone | 203-298-8307
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001709
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License Number State | CT
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