Provider Demographics
NPI:1861094344
Name:BEAUDUY, HENRY LOUIS (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LOUIS
Last Name:BEAUDUY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MN
Mailing Address - Zip Code:56484-0851
Mailing Address - Country:US
Mailing Address - Phone:218-838-9864
Mailing Address - Fax:218-335-4410
Practice Address - Street 1:190 SAILSTAR DR NE
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3565
Practice Address - Country:US
Practice Address - Phone:218-335-3050
Practice Address - Fax:218-335-4410
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2021-009-021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical