Provider Demographics
NPI:1659081578
Name:COMTY-CHARNOCK, BEATRICE MARIE-RACHELLE (LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:MARIE-RACHELLE
Last Name:COMTY-CHARNOCK
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 W LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2717
Mailing Address - Country:US
Mailing Address - Phone:218-838-3729
Mailing Address - Fax:
Practice Address - Street 1:3860 W LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2717
Practice Address - Country:US
Practice Address - Phone:218-838-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health