=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720992803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACON BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 244 W BALTIMORE AVE
-----------------------------------------------------
City | CLIFTON HEIGHTS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19018-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-939-3119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 244 W BALTIMORE AVE
-----------------------------------------------------
City | CLIFTON HEIGHTS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19018-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-939-3119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | KUTUBUL ALAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-939-3119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------