MEDICARE: KELLYN BEESE LPCC

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	101YP2500X	Professional Counselor	C.1700505
2	104100000X	Social Worker	C.1700505
3	101YM0800X	Mental Health Counselor	E.2404762	OH

General Provider Information

NPI Number	:	1790294726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLYN BEESE LPCC

Provider Business Mailing Address
First Line	:	23550 CENTER RIDGE RD STE 102
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-3655
Country	:	US
Telephone Number	:	440-732-5252
Fax Number	:	440-271-2003

Provider Business Practice Location Address
First Line	:	23550 CENTER RIDGE RD STE 102
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-3655
Country	:	US
Telephone Number	:	440-732-5252
Fax Number	:

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

Provider Enumeration Date	:	09/21/2017
Last Update Date	:	10/03/2024

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