Provider Demographics
NPI:1568199842
Name:BEAL, LEA CLAIR (RCSWI)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:CLAIR
Last Name:BEAL
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CACTUS NEEDLE LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6925
Mailing Address - Country:US
Mailing Address - Phone:813-313-0770
Mailing Address - Fax:
Practice Address - Street 1:220 W BRANDON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5100
Practice Address - Country:US
Practice Address - Phone:813-313-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW17538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health