Provider Demographics
NPI:1912952268
Name:BEAUCHAMP, GAIL (LMSW, CACII)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:LMSW, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4077 BLUFF VIEW DR
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-9619
Mailing Address - Country:US
Mailing Address - Phone:906-774-5857
Mailing Address - Fax:
Practice Address - Street 1:325 E H ST
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4760
Practice Address - Country:US
Practice Address - Phone:906-774-3300
Practice Address - Fax:906-779-7446
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010609871041C0700X
MI2-00710101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)