MEDICARE: MR. COLLIN G BEECHER MS, NCC, LPC

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	LPC7271	SD
2	101YP2500X	Professional Counselor	LPC-1376	WY

General Provider Information

NPI Number	:	1861829780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLLIN G BEECHER MS, NCC, LPC

Provider Business Mailing Address
First Line	:	645 N CARRINGTON AVE
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-1525
Country	:	US
Telephone Number	:	307-217-0761
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 N MAIN ST
Second Line	:
City	:	BUFFALO
State	:	WY
Zip	:	82834-1729
Country	:	US
Telephone Number	:	307-217-0761
Fax Number	:

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

Provider Enumeration Date	:	10/09/2013
Last Update Date	:	07/21/2022

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