Beach Street Counseling, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BEACH STREET COUNSELING, LLC

Practice address

140 S Beach St Ste 414
Daytona Beach, FL 32114-4472

Phone

(386) 299-0026

NPI assigned

Oct 17, 2023

Last updated

Oct 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeannie Jenuwine, LCSW, LMSW, CAADCNPI 1851672646

Title

Owner

Phone

(386) 299-0026

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Beach Street Counseling Other name

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Jeannie Jenuwine

  • Clinical Social Worker
  • Daytona Beach, FL
  • NPI 1851672646
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1841072600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 S BEACH ST STE 414",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144472",
            "telephone_number": "386-299-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S BEACH ST STE 414",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144472",
            "telephone_number": "386-299-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACH STREET COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-17",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "JENUWINE",
        "authorized_official_first_name": "JEANNIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-299-0026",
        "authorized_official_credential": "LCSW, LMSW, CAADC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851672646",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beach Street Counseling",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Daniel Beard, DC
• Madeline Bearden, SLPA

• Adult Mental Health Clinic/Center in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Adult Mental Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.