Provider Demographics
NPI:1295544294
Name:BEACHWALK COUNSELING LLC
Entity type:Organization
Organization Name:BEACHWALK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-737-0164
Mailing Address - Street 1:221 W LAKE LANSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8661
Mailing Address - Country:US
Mailing Address - Phone:313-737-0164
Mailing Address - Fax:
Practice Address - Street 1:31119 BEACHWALK DR APT 406
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1444
Practice Address - Country:US
Practice Address - Phone:313-737-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty