| Beenen Therapy Group | |
|
402 4th St N Jacksonville Beach FL 32250-5620 | |
| (904) 624-1960 | |
| Not Available |
| Full Name | Beenen Therapy Group |
|---|---|
| Speciality | Counselor |
| Location | 402 4th St N, Jacksonville Beach, Florida |
| Authorized Official Name and Position | Selina Beenen (OWNER) |
| Authorized Official Contact | 9046241960 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beenen Therapy Group 402 4th St N Jacksonville Beach FL 32250-5620 Ph: (904) 624-1960 | Beenen Therapy Group 402 4th St N Jacksonville Beach FL 32250-5620 Ph: (904) 624-1960 |
| NPI Number | 1144525890 |
|---|---|
| Provider Enumeration Date | 01/11/2011 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Medicare PECOS PAC ID | 2769661081 |
|---|---|
| Medicare Enrollment ID | O20110119000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144525890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | SW10043 (Florida) | Primary |
| Provider Name | Selina W Beenen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922317668 PECOS PAC ID: 8325227168 Enrollment ID: I20110125000856 |
| Provider Name | Lisa Marie Harvey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144081134 PECOS PAC ID: 9931545688 Enrollment ID: I20240315002595 |
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