Provider Demographics
NPI:1922461839
Name:BEACH, KOURTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:LEANNE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4612 POLO JUMP CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5401
Mailing Address - Country:US
Mailing Address - Phone:661-337-0717
Mailing Address - Fax:
Practice Address - Street 1:3000 WEST CECIL AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:661-721-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical