Provider Demographics
NPI:1538524194
Name:BEACHSIDE COUNSELING AND WELLNESS, LLC
Entity type:Organization
Organization Name:BEACHSIDE COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-327-3793
Mailing Address - Street 1:2105 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2929
Mailing Address - Country:US
Mailing Address - Phone:321-327-3793
Mailing Address - Fax:
Practice Address - Street 1:122 4TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3112
Practice Address - Country:US
Practice Address - Phone:321-327-3793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9141261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336264902OtherNPPES