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General NPI Number Information
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NPI Number | 1679466312
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Entity Type | Organization
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Legal Business Name | BEACH WELLBEING LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 506 LAMPLITE LN
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City | WILLISTON
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State | VT
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Zip | 05495-7709
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Country | US
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Telephone | 802-825-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 34 BLAIR PARK RD STE 104 PMB 229
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City | WILLISTON
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State | VT
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Zip | 05495-7991
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Country | US
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Telephone | 802-305-0266
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MIKI BEACH
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Credential | LICSW
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Telephone | 802-305-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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