BEACON ST. PSYCHIATRY NPI 1780460006

NPI Information

NPI: 1780460006
Provider Name: BEACON ST. PSYCHIATRY

Doing Business As: A LIFE RENEWED

Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

Address:
10552 SUCCESS LN STE L
CENTERVILLE, OH
ZIP 45458
Phone: (937) 280-5711
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BEACON ST. PSYCHIATRY is a psychiatric/mental health nurse practitioner in Centerville, OH. BEACON ST. PSYCHIATRY NPI is 1780460006. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As A Life Renewed.

The provider's business location address is:

10552 SUCCESS LN STE L
CENTERVILLE, OH
ZIP 45458-664
Phone: (937) 280-5711

The provider's authorized official is Brad Gibson .
The authorized official title is Ceo/owner and has the following contact phone number (937) 280-5711.

The enumeration date for this NPI number is 9/1/2023 and was last updated on 1/24/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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