Provider Demographics
NPI:1891374930
Name:BEACON BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC-CS, LSW
Authorized Official - Phone:567-201-2048
Mailing Address - Street 1:114 N WOOD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2440
Mailing Address - Country:US
Mailing Address - Phone:567-201-2048
Mailing Address - Fax:
Practice Address - Street 1:114 N WOOD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2440
Practice Address - Country:US
Practice Address - Phone:567-201-2048
Practice Address - Fax:567-280-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health