| Organization Name: | BEACHSIDE COUNSELING AND WELLNESS, LLC |
| NPI Number: | 1538524194 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LUCY LAUER (OWNER) |
| Mailing Address: | 122 4th Ave Suite 200 Indialantic |
| State: | FL US |
| Postal Code: | 329033112 |
| Phone Number: | 3213273793 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2015 |
| NPI Last Update Date: | 12/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | MH9141 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |