Provider Demographics
NPI:1104599331
Name:BEACHSIDE COUNSELING LLC
Entity type:Organization
Organization Name:BEACHSIDE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LMHCA, LAMFT
Authorized Official - Phone:208-274-3020
Mailing Address - Street 1:1250 W IRONWOOD DR STE 330
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2682
Mailing Address - Country:US
Mailing Address - Phone:208-274-3020
Mailing Address - Fax:
Practice Address - Street 1:1250 W IRONWOOD DR STE 330
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2682
Practice Address - Country:US
Practice Address - Phone:208-964-4523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)