Basic Information
| Provider Information | |||||||||
| NPI: | 1063440568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEACH | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | LMSW, ACSW, BCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25797 ARCADIA DR | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483742444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | 2482130521 | ||||||||
| Practice Location | |||||||||
| Address1: | 29201 TELEGRAPH RD | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482130501 | ||||||||
| FaxNumber: | 2482130521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801014015 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 359631 | 01 | MI | MHN | OTHER | 4449385 | 01 | MI | AETNA INS CO | OTHER | 11543639 | 01 | MI | CAQH | OTHER | 253315 | 01 | MI | COMP PSYCH | OTHER |