Provider Demographics
NPI:1316996192
Name:BEACH, CORNELIA C (MA LPC LMFT)
Entity type:Individual
Prefix:MS
First Name:CORNELIA
Middle Name:C
Last Name:BEACH
Suffix:
Gender:F
Credentials:MA LPC LMFT
Other - Prefix:
Other - First Name:CORNELIA
Other - Middle Name:CHILDS
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7272 WURZBACH
Mailing Address - Street 2:#1504
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-647-7707
Mailing Address - Fax:210-647-7805
Practice Address - Street 1:7272 WURZBACH
Practice Address - Street 2:SUITE 1504
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-647-7707
Practice Address - Fax:210-647-7805
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11625101YP2500X
TX003352042641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist