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NPI Code Detail

MEDICARE: ANGIE BEAUBRUN

MEDICARE: ANGIE BEAUBRUN
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
1101YM0800XMental Health CounselorFL

General Provider Information

NPI Number : 1699440198
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE BEAUBRUN
Provider Business Mailing Address
First Line : 2963 GULF TO BAY BLVD STE 320
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-4286
Country : US
Telephone Number : 727-241-8946
Fax Number : 727-241-8946
Provider Business Practice Location Address
First Line : 2963 GULF TO BAY BLVD STE 320
Second Line :
City : CLEARWATER
State : FL
Zip : 33759-4286
Country : US
Telephone Number : 727-241-8946
Fax Number : 727-241-8946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2021
Last Update Date : 08/16/2021

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