Provider Demographics
NPI:1942998695
Name:OAK VISTA COUNSELING PLLC
Entity Type:Organization
Organization Name:OAK VISTA COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:III
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-840-9864
Mailing Address - Street 1:602 E HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2240
Mailing Address - Country:US
Mailing Address - Phone:217-840-9864
Mailing Address - Fax:
Practice Address - Street 1:3526 N CALIFORNIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-1143
Practice Address - Country:US
Practice Address - Phone:773-234-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty