1467534875 NPI number — MRS. MICHELE A BEACH RPT

Table of content: MRS. KATIE JANE SANTANA LCSW (NPI 1902054489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467534875 NPI number — MRS. MICHELE A BEACH RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEACH
Provider First Name:
MICHELE
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIFONZO
Provider Other First Name:
MICHELE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467534875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 MCFARLAND BLVD NE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-2265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-344-4443
Provider Business Mailing Address Fax Number:
205-344-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 MCFARLAND BLVD NE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35406-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-344-4443
Provider Business Practice Location Address Fax Number:
205-344-4055
Provider Enumeration Date:
10/19/2006

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: 225100000X , with the licence number:  PTH3069 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51521175 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com