Provider Demographics
NPI:1578753166
Name:BEAULIEU, TINA MARIE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12827 EMERSONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6353
Mailing Address - Country:US
Mailing Address - Phone:978-994-6271
Mailing Address - Fax:
Practice Address - Street 1:53 CASTLE RD
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1102
Practice Address - Country:US
Practice Address - Phone:781-593-6229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health