MEDICARE: DR. DANIELLE J. BEAUVAIS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301016029	MI
2	103TC0700X	Clinical Psychologist	PS015193	PA

General Provider Information

NPI Number	:	1346264603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE J. BEAUVAIS PSY.D.

Provider Business Mailing Address
First Line	:	605 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2419
Country	:	US
Telephone Number	:	215-300-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2419
Country	:	US
Telephone Number	:	215-300-6306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	08/03/2021

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