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NPI Code Detail

MEDICARE: BEACHSIDE COUNSELING AND WELLNESS, LLC

MEDICARE: BEACHSIDE COUNSELING AND WELLNESS, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)MH9141FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11336264902OTHERFLNPPES

General Provider Information

NPI Number : 1538524194
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACHSIDE COUNSELING AND WELLNESS, LLC
Provider Business Mailing Address
First Line : 2105 S RIVER RD
Second Line :
City : MELBOURNE BEACH
State : FL
Zip : 32951-2929
Country : US
Telephone Number : 321-327-3793
Fax Number :
Provider Business Practice Location Address
First Line : 122 4TH AVE
Second Line : SUITE 200
City : INDIALANTIC
State : FL
Zip : 32903-3112
Country : US
Telephone Number : 321-327-3793
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LUCY LAUER
Credential : LMHC
Telephone Number : 321-327-3793
Provider Enumeration Date : 12/28/2015
Last Update Date : 12/28/2015

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Directions to “BEACHSIDE COUNSELING AND WELLNESS, LLC ” Practice Location

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