Provider Demographics
NPI:1114218807
Name:BEACON COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:BEACON COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-429-9000
Mailing Address - Street 1:3665 S LAKESHORE DR
Mailing Address - Street 2:3665 SOUTH LAKESHORE DRIVE
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8277
Mailing Address - Country:US
Mailing Address - Phone:269-429-9000
Mailing Address - Fax:
Practice Address - Street 1:3665 S LAKESHORE DR
Practice Address - Street 2:3665 SOUTH LAKESHORE DRIVE
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8277
Practice Address - Country:US
Practice Address - Phone:269-429-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty