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General NPI Number Information
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NPI Number | 1639603335
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Entity Type | Organization
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Legal Business Name | BEACON BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 3044 MICHIGAN AVE
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City | KISSIMMEE
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State | FL
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Zip | 34744-1210
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Country | US
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Telephone | 407-927-9617
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Fax |
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Provider Business Mailing Address
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Address Line | 3044 MICHIGAN AVE
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City | KISSIMMEE
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State | FL
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Zip | 34744-1210
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Country | US
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Telephone | 407-927-9617
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARIANNE LOPEZ
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Credential |
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Telephone | 407-927-9619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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