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NPI Code Detail

MEDICARE: GLENDA GAIL BEACH LMFT

MEDICARE:   GLENDA GAIL BEACH  LMFT
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
1106H00000XMarriage & Family TherapistMT1714FL

General Provider Information

NPI Number : 1457421323
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENDA GAIL BEACH LMFT
Provider Business Mailing Address
First Line : 331 BAY ARBOR BLVD
Second Line :
City : OLDSMAR
State : FL
Zip : 34677-4617
Country : US
Telephone Number : 727-787-0646
Fax Number : 813-814-4352
Provider Business Practice Location Address
First Line : 3980 TAMPA RD
Second Line : SUITE 205
City : OLDSMAR
State : FL
Zip : 34677-3223
Country : US
Telephone Number : 727-787-0646
Fax Number : 813-814-4352
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/05/2015

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Directions to “ GLENDA GAIL BEACH LMFT” Practice Location

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