Provider Demographics
NPI:1922257518
Name:BEAUREGARD, COURTNEY LEE (LPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:BEAUREGARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4760
Mailing Address - Country:US
Mailing Address - Phone:508-250-3733
Mailing Address - Fax:
Practice Address - Street 1:11 OHIO ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4760
Practice Address - Country:US
Practice Address - Phone:508-250-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC010285OtherSTATE LICENSE