Provider Demographics
NPI:1770823999
Name:BEACH, ROBERT III (LCPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BEACH
Suffix:III
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 E HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2240
Mailing Address - Country:US
Mailing Address - Phone:773-234-3574
Mailing Address - Fax:
Practice Address - Street 1:208 S 1ST AVE STE G
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2044
Practice Address - Country:US
Practice Address - Phone:773-234-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008467101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)