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General NPI Number Information
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NPI Number | 1750998043
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Entity Type | Individual
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Provider Name | DEBORAH KOONS-BEAUCHAMP LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 302 S MAIN ST
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City | ALGONQUIN
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State | IL
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Zip | 60102-2641
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Country | US
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Telephone | 319-431-0087
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Fax |
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Provider Business Mailing Address
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Address Line | 302 S MAIN ST
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City | ALGONQUIN
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State | IL
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Zip | 60102-2641
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Country | US
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Telephone | 319-431-0087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101007407
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001699
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License Number State | IL
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