Provider Demographics
NPI:1235768946
Name:BEAULIEU, ALIZA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ALIZA
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 RENAISSANCE WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8228
Mailing Address - Country:US
Mailing Address - Phone:561-319-2114
Mailing Address - Fax:
Practice Address - Street 1:2410 RENAISSANCE WAY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8228
Practice Address - Country:US
Practice Address - Phone:561-319-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health