Provider Demographics
NPI:1295024214
Name:RESTREPO BEAUX, GLORIA LUCIA (LMHC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:LUCIA
Last Name:RESTREPO BEAUX
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 1:1506 E LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-4412
Mailing Address - Country:US
Mailing Address - Phone:407-883-8346
Mailing Address - Fax:
Practice Address - Street 1:1506 E LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-4412
Practice Address - Country:US
Practice Address - Phone:407-883-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health