Individual provider Active NPI

Mireille Beauchaine Reece, PSY.D.

  • Psychologist
  • Silverdale, WA
National Provider Identifier
1841434123
Registry record updated Nov 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY00003946 Issued in WA
Practice address
1191 NE Tahoe Lane
Silverdale, WA 98383
Phone
(360) 698-4860
Fax
(360) 698-3849
NPI assigned
Apr 30, 2009
Last updated
Nov 13, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 3946 WA
Psychologist 103T00000X PY00003946 WA Primary
Psychologist 103T00000X 33826 TX

Addresses

Primary practice location

1191 NE Tahoe Lane
Silverdale, WA 98383

Mailing address

1191 NW Tahoe Lane
Silverdale, WA 98383
Phone (360) 698-4860

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240821004276 AZ Practitioner - Clinical Psychologist 3476603416 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Care Center LLCGroup PAC ID 5991064420, 703 clinicians

Practice addresses (Care Compare)

1910 S Stapley Dr
Suite 209
Mesa, AZ 85204-6679
Phone (888) 362-5953

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY00003946WAMDPsychologist
33826TXMDClinical Social Worker
3946WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Center, LLC Psychologist CurrentSince Nov 27, 2024 Accepting new patients
Spectrum Psychology and Wellness, LLC Clinical CurrentSince Aug 5, 2024 Accepting new patients

Locations

1772 E Boston St
Ste 105
Gilbert, AZ 85295
Phone (480) 621-7257

1910 S Stapley Dr
Ste 209
Mesa, AZ 85204
Phone (480) 351-8020

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1241049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352764800000",
    "number": "1841434123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 NW TAHOE LANE",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "98383",
            "telephone_number": "360-698-4860",
            "fax_number": "360-698-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 NE TAHOE LANE",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "98383",
            "telephone_number": "360-698-4860",
            "fax_number": "360-698-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REECE",
        "first_name": "MIREILLE",
        "middle_name": "BEAUCHAINE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-30",
        "last_updated": "2012-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "3946",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY00003946",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "33826",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

Verify at the official NPI Registry.