Provider Demographics
NPI:1790463735
Name:MICHELLE BEAUDOIN LICENSED PROFESSIONAL CLINICAL COUNSELOR APC
Entity Type:Organization
Organization Name:MICHELLE BEAUDOIN LICENSED PROFESSIONAL CLINICAL COUNSELOR APC
Other - Org Name:MICHELLE BEAUDOIN BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LPC, LMHC
Authorized Official - Phone:442-216-6093
Mailing Address - Street 1:3 ALONDA
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1720
Mailing Address - Country:US
Mailing Address - Phone:442-216-6093
Mailing Address - Fax:
Practice Address - Street 1:3 ALONDA
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1720
Practice Address - Country:US
Practice Address - Phone:442-216-6093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty