Provider Demographics
NPI:1457821076
Name:BEATON, ROXANNE JULIET (LMH)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:JULIET
Last Name:BEATON
Suffix:
Gender:F
Credentials:LMH
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:JULIET
Other - Last Name:RALPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12814 UNIVERSITY CLUB DRIVE APT 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6753
Mailing Address - Country:US
Mailing Address - Phone:718-755-6840
Mailing Address - Fax:
Practice Address - Street 1:23540 STATE RD. 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:718-755-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health