Provider Demographics
NPI:1912627266
Name:BEACH THERAPY CONSULTING
Entity type:Organization
Organization Name:BEACH THERAPY CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-675-7151
Mailing Address - Street 1:12701 CINQUETERRE DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-4076
Mailing Address - Country:US
Mailing Address - Phone:201-675-7151
Mailing Address - Fax:
Practice Address - Street 1:12701 CINQUETERRE DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-4076
Practice Address - Country:US
Practice Address - Phone:201-675-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19212OtherLCSW