| The Beacon Clinic, Pllc | |
|
790 Cleveland Ave S Suite 201 Saint Paul MN 55116-3858 | |
| (651) 805-1752 | |
| Not Available |
| Full Name | The Beacon Clinic, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 790 Cleveland Ave S, Saint Paul, Minnesota |
| Authorized Official Name and Position | Heather P Libbey (LICENSED PSYCHOLOGIST/DIRECTOR) |
| Authorized Official Contact | 6518051752 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Beacon Clinic, Pllc 790 Cleveland Ave S Suite 201 Saint Paul MN 55116-3858 Ph: (651) 805-1752 | The Beacon Clinic, Pllc 790 Cleveland Ave S Suite 201 Saint Paul MN 55116-3858 Ph: (651) 805-1752 |
| NPI Number | 1023357175 |
|---|---|
| Provider Enumeration Date | 02/10/2013 |
| Last Update Date | 08/07/2013 |
| Medicare PECOS PAC ID | 7416199989 |
|---|---|
| Medicare Enrollment ID | O20130813000274 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023357175 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 5282 (Minnesota) | Primary |
| Provider Name | Heather P Libbey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932414299 PECOS PAC ID: 8729274212 Enrollment ID: I20101123000558 |
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