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General NPI Number Information
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NPI Number | 1871069344
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Entity Type | Organization
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Legal Business Name | GENTLE BEACON, LLC
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 101 FOUNDRY DR STE 1200
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-3446
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Country | US
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Telephone | 765-299-6807
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Fax | 765-637-7402
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Provider Business Mailing Address
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Address Line | 101 FOUNDRY DR STE 1200
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-3446
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Country | US
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Telephone | 765-299-6807
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Fax | 765-637-7402
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Authorized Official
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Title or Position | STEWARD
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Name | CHRISTOPHER HUTCHESON
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Credential | LCSW
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Telephone | 765-299-6807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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