Provider Demographics
NPI:1215294301
Name:BEACH, NANCY J (LPC, RN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:BEACH
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S 8TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7022
Mailing Address - Country:US
Mailing Address - Phone:719-358-7194
Mailing Address - Fax:
Practice Address - Street 1:1355 S 8TH ST STE 206
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905
Practice Address - Country:US
Practice Address - Phone:719-358-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-117289374T00000X
LPC-6034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel