Provider Demographics
NPI:1407379787
Name:BEACON MENTAL HEALTH RESOURCES LLC
Entity Type:Organization
Organization Name:BEACON MENTAL HEALTH RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-308-5742
Mailing Address - Street 1:1421 BROADWAY ST N STE 114B
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-4728
Mailing Address - Country:US
Mailing Address - Phone:715-308-5742
Mailing Address - Fax:888-972-4831
Practice Address - Street 1:1421 BROADWAY ST N STE 114B
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-4728
Practice Address - Country:US
Practice Address - Phone:715-308-5742
Practice Address - Fax:888-972-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1518241876OtherINDIVIDUAL NPI