=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548283963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY IRENE RALSTON-BEIKE LPC, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3125 W DURANGO ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85009-6217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-506-0447
-----------------------------------------------------
Fax | 602-372-4800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CHANDLER UNITED SCHOOL DISTRICT/HILL LEARNING ACADEMY 290 S. COOPER RD
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-812-7166
-----------------------------------------------------
Fax | 602-372-4800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5089-T
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC13118
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------