NPIMap

Organization Active NPI

Beacon Clinic, Inc.

  • Mental Health Counselor
  • Port Charlotte, FL
National Provider Identifier
1194803734
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
NP2596452 Issued in FL
Legal business name
BEACON CLINIC, INC.
Practice address
3821 Tamiami TRL # D
Port Charlotte, FL 33952-8377
Phone
(941) 629-7855
Fax
(941) 629-9589
NPI assigned
Nov 1, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Noel E Holdsworth I, ARNPNPI 1811931058
Title
Director
Phone
(941) 629-7855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X NP2596452 FL Primary

Addresses

Primary practice location

3821 Tamiami TRL # D
Port Charlotte, FL 33952-8377

Mailing address

3821 Tamiami TRL # D
Port Charlotte, FL 33952-8377
Phone (941) 629-7855

Other names 1

  • Beacon Clinic Former legal business name

National Provider Directory

National Provider Directory

Locations

3821 Tamiami Trl
#D
Pt Charlotte, FL 33952
Phone (941) 629-7855

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194803734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3821 TAMIAMI TRL # D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528377",
            "telephone_number": "941-629-7855",
            "fax_number": "941-629-9589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3821 TAMIAMI TRL # D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528377",
            "telephone_number": "941-629-7855",
            "fax_number": "941-629-9589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLDSWORTH",
        "authorized_official_first_name": "NOEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "941-629-7855",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "NP2596452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beacon Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.