Provider Demographics
NPI:1851015358
Name:BEAUCHAMP, ANN E (LPCC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 CAMINO LUMBRE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5631
Mailing Address - Country:US
Mailing Address - Phone:505-920-6595
Mailing Address - Fax:
Practice Address - Street 1:1863 CAMINO LUMBRE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5631
Practice Address - Country:US
Practice Address - Phone:505-920-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NMCCMH0167951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral