1417022047 NPI number — MS. SHERRY SIMS BEACH LCPC

Table of content: MS. SHERRY SIMS BEACH LCPC (NPI 1417022047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417022047 NPI number — MS. SHERRY SIMS BEACH LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEACH
Provider First Name:
SHERRY
Provider Middle Name:
SIMS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEACH
Provider Other First Name:
SHERRY
Provider Other Middle Name:
SIMS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1417022047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 EAST MAIN STREET, SHERRY SIMS BEACH LCPC
Provider Second Line Business Mailing Address:
SUITE 311
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-6241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-587-5987
Provider Business Mailing Address Fax Number:
406-586-8749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 EAST MAIN STREET, SHERRY SIMS BEACH LCPC
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-587-5987
Provider Business Practice Location Address Fax Number:
406-586-8749
Provider Enumeration Date:
11/21/2006

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 , with the licence number:  525 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: BBH-LPC-LIC-252 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: BBH-LPC-LIC-252 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 75136 . This is a "BCBS OF MT PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 7754331 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0255515 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".