Provider Demographics
NPI:1346859642
Name:NEW BEGINNINGS OUTPATIENT THERAPY, LLC
Entity Type:Organization
Organization Name:NEW BEGINNINGS OUTPATIENT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-869-4350
Mailing Address - Street 1:601 E LAKESHORE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-1692
Mailing Address - Country:US
Mailing Address - Phone:906-869-4350
Mailing Address - Fax:
Practice Address - Street 1:601 E LAKESHORE DR STE 102
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1692
Practice Address - Country:US
Practice Address - Phone:906-869-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health