Provider Demographics
NPI:1679247829
Name:BEAMISH, NINA NICHOLE
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:NICHOLE
Last Name:BEAMISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:SIEMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 MICA TRL
Mailing Address - Street 2:
Mailing Address - City:MAXWELL
Mailing Address - State:TX
Mailing Address - Zip Code:78656-2009
Mailing Address - Country:US
Mailing Address - Phone:630-877-0041
Mailing Address - Fax:
Practice Address - Street 1:7000 BEE CAVES RD STE 325
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5009
Practice Address - Country:US
Practice Address - Phone:512-684-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88308101YP2500X
IL178.017119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional