Provider Demographics
NPI:1841868957
Name:BEAULIEU, NATHAN J (ALC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 OLD MADISON PIKE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1225
Mailing Address - Country:US
Mailing Address - Phone:256-690-8233
Mailing Address - Fax:
Practice Address - Street 1:190 LIME QUARRY RD STE 111
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8975
Practice Address - Country:US
Practice Address - Phone:256-278-2802
Practice Address - Fax:256-325-0744
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health