MEDICARE: BEACH BEHAVIOR 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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1659149110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH BEHAVIOR LLC

Provider Business Mailing Address
First Line	:	6401 S WEST SHORE BLVD APT 210S
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-1384
Country	:	US
Telephone Number	:	540-729-5937
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 S WEST SHORE BLVD APT 210S
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33616-1384
Country	:	US
Telephone Number	:	540-729-5937
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY MARIE SCHIETINGER
Credential	:	MS, BCBA
Telephone Number	:	540-729-5937

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/15/2023

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