MEDICARE: AMY IRENE RALSTON-BEIKE LPC, MS

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	101YP2500X	Professional Counselor	5089-T	AZ
2	101YP2500X	Professional Counselor	LPC13118	AZ

General Provider Information

NPI Number	:	1548283963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY IRENE RALSTON-BEIKE LPC, MS

Provider Business Mailing Address
First Line	:	CHANDLER UNITED SCHOOL DISTRICT/HILL LEARNING ACADEMY
Second Line	:	290 S. COOPER RD
City	:	CHANDLER
State	:	AZ
Zip	:	85225
Country	:	US
Telephone Number	:	480-812-7166
Fax Number	:	602-372-4800

Provider Business Practice Location Address
First Line	:	3125 W DURANGO ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-6217
Country	:	US
Telephone Number	:	602-506-0447
Fax Number	:	602-372-4800

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	03/08/2022

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