Provider Demographics
NPI:1639959141
Name:BEAL, ALEXANDER QUENTIN (LPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:QUENTIN
Last Name:BEAL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 GREEN BAY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2967
Mailing Address - Country:US
Mailing Address - Phone:262-806-1467
Mailing Address - Fax:
Practice Address - Street 1:4003 80TH ST STE 101
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4995
Practice Address - Country:US
Practice Address - Phone:262-806-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10268-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional