Provider Demographics
NPI:1710524673
Name:BEACON COUNSELING AND CONSULTATION, PLLC
Entity Type:Organization
Organization Name:BEACON COUNSELING AND CONSULTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:828-358-9061
Mailing Address - Street 1:2247 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5319
Mailing Address - Country:US
Mailing Address - Phone:828-270-9774
Mailing Address - Fax:
Practice Address - Street 1:2247 S CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5319
Practice Address - Country:US
Practice Address - Phone:828-270-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1174026710OtherNPI