MEDICARE: BEYOND IDEAS 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	251S00000X	Community/Behavioral Health Agency
2	251S00000X	Community/Behavioral Health Agency	0187211	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710398821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND IDEAS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1126
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66505-1126
Country	:	US
Telephone Number	:	505-440-7169
Fax Number	:	888-972-1885

Provider Business Practice Location Address
First Line	:	330 POYNTZ AVE STE 272
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-8039
Country	:	US
Telephone Number	:	505-379-1270
Fax Number	:	888-972-1885

Authorized Official
Title or Position	:	OWNER
Name	:	LACEY STEWART
Credential	:	LPCC
Telephone Number	:	505-440-7169

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	10/17/2022

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