Provider Demographics
NPI:1346510930
Name:BEECH, TARA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BEECH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ENTERPRISE PATH
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2656
Mailing Address - Country:US
Mailing Address - Phone:678-567-0920
Mailing Address - Fax:
Practice Address - Street 1:126 ENTERPRISE PATH
Practice Address - Street 2:SUITE 201
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2656
Practice Address - Country:US
Practice Address - Phone:678-567-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional