Provider Demographics
NPI:1457421323
Name:BEACH, GLENDA GAIL (LMFT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:GAIL
Last Name:BEACH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BAY ARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4617
Mailing Address - Country:US
Mailing Address - Phone:727-787-0646
Mailing Address - Fax:813-814-4352
Practice Address - Street 1:3980 TAMPA RD
Practice Address - Street 2:SUITE 205
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3223
Practice Address - Country:US
Practice Address - Phone:727-787-0646
Practice Address - Fax:813-814-4352
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1714106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist