Provider Demographics
NPI:1649938507
Name:BEACON PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:BEACON PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KREINER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:614-560-3322
Mailing Address - Street 1:1135 KILDAIRE FARM RD STE 315
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4587
Mailing Address - Country:US
Mailing Address - Phone:919-794-5490
Mailing Address - Fax:
Practice Address - Street 1:1135 KILDAIRE FARM RD STE 315
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4587
Practice Address - Country:US
Practice Address - Phone:919-794-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty