MEDICARE: BEYOUTIFULLY MADE COUNSELING 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1588121438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOUTIFULLY MADE COUNSELING LLC

Provider Business Mailing Address
First Line	:	539 CRAFTSMAN LN
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-5479
Country	:	US
Telephone Number	:	828-489-1064
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 CRAFTSMAN LN
Second Line	:
City	:	BOILING SPRINGS
State	:	SC
Zip	:	29316-5479
Country	:	US
Telephone Number	:	828-489-1064
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MRS. JONEISHA PARSON
Credential	:	LCSW
Telephone Number	:	828-489-1064

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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