Basic Information
| Provider Information | |||||||||
| NPI: | 1851435523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEYNON | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | LISW-S, LICDC-CS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1495 SUNFLOWER RD | ||||||||
| Address2: | |||||||||
| City: | NEW CONCORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437629671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776927247 | ||||||||
| FaxNumber: | 8776927247 | ||||||||
| Practice Location | |||||||||
| Address1: | 1495 SUNFLOWER RD | ||||||||
| Address2: | |||||||||
| City: | NEW CONCORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437629671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556927247 | ||||||||
| FaxNumber: | 8556927247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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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 | I.0700055-SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | ICDC.101038-CS | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.