Provider Demographics
NPI:1710425236
Name:BEACONSTAR COUNSELING, LLC
Entity Type:Organization
Organization Name:BEACONSTAR COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRADC
Authorized Official - Phone:417-882-7827
Mailing Address - Street 1:3032 S FREMONT AVE
Mailing Address - Street 2:SUITE C200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4210
Mailing Address - Country:US
Mailing Address - Phone:417-882-7827
Mailing Address - Fax:
Practice Address - Street 1:3032 S FREMONT AVE
Practice Address - Street 2:SUITE C200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4210
Practice Address - Country:US
Practice Address - Phone:417-882-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002112 (LPC)261QM0850X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health