Doctor Name: | SHIROMI BEACH |
NPI Number: | 1356746358 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPCC |
License Number: | LPC 1443 |
Business Practice Address: | 111 Hundertmark Rd 205n Chaska, MN - 553184551 |
Business Phone Number: | 9529031377 |
Business Fax Number: | 9524263856 |
Mailing Address: | 8500 5th Ave S, BLOOMINGTON |
State: | MN |
Postal Code: | 554202334 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/03/2014 |
NPI Last Update Date: | 11/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC 1443 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |