Provider Demographics
NPI:1134682271
Name:BEACH COUNSELING AND COACHING LLC
Entity Type:Organization
Organization Name:BEACH COUNSELING AND COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREUTZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-742-6667
Mailing Address - Street 1:1 CHANNEL DR UNIT 810
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1307
Mailing Address - Country:US
Mailing Address - Phone:732-742-6667
Mailing Address - Fax:
Practice Address - Street 1:120 E RIVER RD STE 2
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1631
Practice Address - Country:US
Practice Address - Phone:732-305-4532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60054OtherAETNA