Provider Demographics
NPI:1891147120
Name:BEECH COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BEECH COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:BEECH-MAVRANTZAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-994-8551
Mailing Address - Street 1:1849 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4520
Mailing Address - Country:US
Mailing Address - Phone:904-994-8551
Mailing Address - Fax:
Practice Address - Street 1:1849 DEAN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4520
Practice Address - Country:US
Practice Address - Phone:904-994-8551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW136921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty