Provider Demographics
NPI:1730495979
Name:BEAULIEU, LEONARD RENE (MED, CACIII)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:RENE
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:MED, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:405 CASTLE CREEK RD
Practice Address - Street 2:STE 9
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-3125
Practice Address - Country:US
Practice Address - Phone:970-920-5555
Practice Address - Fax:970-920-5557
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CO6918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor