| Organization Name: | BEACHES RECOVERY SERVICES |
| NPI Number: | 1073907937 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KYLE MARCOTTE (OWNER) |
| Mailing Address: | 17 La Vista Dr Ponte Vedra |
| State: | FL US |
| Postal Code: | 320822305 |
| Phone Number: | 9547468232 |
| Fax Number: | 9547468231 |
| NPI Enumeration Date: | 03/27/2015 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |