Provider Demographics
NPI:1558648212
Name:BEACH, TRICIA (LPC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 CHEROKEE ROSE TRL
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7694
Mailing Address - Country:US
Mailing Address - Phone:816-260-1230
Mailing Address - Fax:
Practice Address - Street 1:1717 CHEROKEE ROSE TRL
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TX
Practice Address - Zip Code:76227-7694
Practice Address - Country:US
Practice Address - Phone:816-260-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74843101YP2500X
MO2011035732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health