1316410012 NPI number — MRS. JANESSA ANGELICA BEEBE MA, LPCC

Table of content: MRS. JANESSA ANGELICA BEEBE MA, LPCC (NPI 1316410012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316410012 NPI number — MRS. JANESSA ANGELICA BEEBE MA, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEEBE
Provider First Name:
JANESSA
Provider Middle Name:
ANGELICA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316410012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CORNERSTONE THERAPY AND RECOVERY CENTER
Provider Second Line Business Mailing Address:
1600 UNIVERSITY AVENUE WEST SUITE #203
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-645-0980
Provider Business Mailing Address Fax Number:
651-645-3534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CORNERSTONE THERAPY AND RECOVERY CENTER
Provider Second Line Business Practice Location Address:
1600 UNIVERSITY AVENUE WEST SUITE #203
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-645-0980
Provider Business Practice Location Address Fax Number:
651-645-3534
Provider Enumeration Date:
01/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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