Provider Demographics
NPI:1134541014
Name:BEACH, KRISTIANE MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIANE
Middle Name:MARIE
Last Name:BEACH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7962 OAK MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8638
Mailing Address - Country:US
Mailing Address - Phone:616-780-1182
Mailing Address - Fax:
Practice Address - Street 1:7962 OAK MEADOW CT
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8638
Practice Address - Country:US
Practice Address - Phone:616-780-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010903861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical