Provider Demographics
NPI:1710252747
Name:BEECH, JERRY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:BEECH
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NW SHERIDAN RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6520
Mailing Address - Country:US
Mailing Address - Phone:580-536-5102
Mailing Address - Fax:580-536-5102
Practice Address - Street 1:305 NW SHERIDAN RD STE C
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6520
Practice Address - Country:US
Practice Address - Phone:580-536-5102
Practice Address - Fax:580-536-5102
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2266101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor