MEDICARE: DIANE ANNETTE BEERS LMFT

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	106H00000X	Marriage & Family Therapist	1275	MN

General Provider Information

NPI Number	:	1700095312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ANNETTE BEERS LMFT

Provider Business Mailing Address
First Line	:	1967 GARDEN LN
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-6607
Country	:	US
Telephone Number	:	651-442-3785
Fax Number	:	651-426-9250

Provider Business Practice Location Address
First Line	:	1967 GARDEN LN
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-6607
Country	:	US
Telephone Number	:	651-442-3785
Fax Number	:	651-426-9250

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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