Provider Demographics
NPI:1235664368
Name:BEACH STONE COUNSELING
Entity Type:Organization
Organization Name:BEACH STONE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:305-522-5105
Mailing Address - Street 1:2641 E ATLANTIC BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4979
Mailing Address - Country:US
Mailing Address - Phone:754-300-6127
Mailing Address - Fax:
Practice Address - Street 1:2641 E ATLANTIC BLVD STE 308
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4979
Practice Address - Country:US
Practice Address - Phone:754-300-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-00092519251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health