Provider Demographics
NPI:1013549328
Name:BEACH BLUE COUNSELING
Entity Type:Organization
Organization Name:BEACH BLUE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCORRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:850-359-6444
Mailing Address - Street 1:PO BOX 6717
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-1010
Mailing Address - Country:US
Mailing Address - Phone:850-502-1777
Mailing Address - Fax:850-650-0365
Practice Address - Street 1:327 S COUNTY HIGHWAY 393 UNIT 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-8209
Practice Address - Country:US
Practice Address - Phone:850-359-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2022-02-11
Deactivation Date:2021-11-01
Deactivation Code:
Reactivation Date:2022-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty