Provider Demographics
NPI:1104004217
Name:BEACH COUNSELING & TESTING, INC.
Entity Type:Organization
Organization Name:BEACH COUNSELING & TESTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BINNIX
Authorized Official - Suffix:
Authorized Official - Credentials:PLCMH
Authorized Official - Phone:302-703-2213
Mailing Address - Street 1:17169 JAYS WAY
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3413
Mailing Address - Country:US
Mailing Address - Phone:302-703-2213
Mailing Address - Fax:302-703-2744
Practice Address - Street 1:17169 JAYS WAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3413
Practice Address - Country:US
Practice Address - Phone:302-703-2213
Practice Address - Fax:302-703-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000419101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1124206271Medicaid