MEDICARE: BEACHSIDE THERAPY PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932084639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACHSIDE THERAPY PLLC

Provider Business Mailing Address
First Line	:	4701 CEDAR LN SW
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-7533
Country	:	US
Telephone Number	:	812-820-9019
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 CEDAR LN SW
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-7533
Country	:	US
Telephone Number	:	812-820-9019
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. TAYLOR RENEE GUILL
Credential	:	MS, LCMHCA, NCC
Telephone Number	:	252-320-9179

Provider Enumeration Date	:	08/11/2025
Last Update Date	:	08/11/2025

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