=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679965230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACHES COUNSELING & THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2015
-----------------------------------------------------
Last Update Date | 01/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2380 3RD ST S SUITE 2
-----------------------------------------------------
City | JACKSONVILLE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32250-4072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-853-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2380 3RD ST S SUITE 2
-----------------------------------------------------
City | JACKSONVILLE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32250-4072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-853-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MARRIAGE& FAMILY THERAPIST
-----------------------------------------------------
Name | CHRISTIE CASTNER MCDOWELL
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 904-853-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2927
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------