Provider Demographics
NPI:1821782798
Name:BEACH, BRIDGET AILEEN (LMFT-IT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:AILEEN
Last Name:BEACH
Suffix:
Gender:F
Credentials:LMFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 COUNTY ROAD Y
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-9323
Mailing Address - Country:US
Mailing Address - Phone:920-382-4271
Mailing Address - Fax:
Practice Address - Street 1:3233A BUSINESS PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8861
Practice Address - Country:US
Practice Address - Phone:800-681-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1035-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist