Active NPI
Carly Beaulieu
- Student in an Organized Health Care Education/Training Program
- Auburn, WA
National Provider Identifier
1063821551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 4238 Auburn Way N
Auburn, WA 98002 - Phone
- (253) 876-7600
- Fax
- (253) 876-7610
- NPI assigned
- Aug 8, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG60472473 | WA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
4238 Auburn Way N
Auburn, WA 98002
Mailing address
4238 Auburn Way N
Auburn, WA 98002-1311
Phone (253) 876-7600
Other practice location 1
6908 30th Ave S
Seattle, WA 98108-3768
Phone (206) 960-4285
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 16, 2024 through May 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60472473 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535328000000",
"number": "1063821551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4238 AUBURN WAY N",
"city": "AUBURN",
"state": "WA",
"postal_code": "980021311",
"telephone_number": "253-876-7600",
"fax_number": "253-876-7610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4238 AUBURN WAY N",
"city": "AUBURN",
"state": "WA",
"postal_code": "98002",
"telephone_number": "253-876-7600",
"fax_number": "253-876-7610"
}
],
"practiceLocations": [
{
"address_1": "6908 30th Ave S",
"address_purpose": "LOCATION",
"city": "Seattle",
"state": "WA",
"postal_code": "981083768",
"country_code": "US",
"telephone_number": "206-960-4285",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BEAULIEU",
"first_name": "CARLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-08-08",
"last_updated": "2018-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG60472473",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.