Octavia Beal
Individual provider Active NPI Professional Counselor · Canton, MI
NPI 1962092254 · NPPES record last updated Jan 21, 2021
Key facts
- NPI
- 1962092254
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 6401018633 (MI)
- Practice address
- 42513 Ashley CT
Canton, MI 48187-2301 - Phone
- (734) 837-1889
- NPI assigned
- Jan 21, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401018633 | MI | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401018633 | MI | Yes |
Addresses
Primary practice location
42513 Ashley CT
Canton, MI 48187-2301
Mailing address
42513 Ashley CT
Canton, MI 48187-2301
Phone (734) 837-1889
Other providers in Canton, MI
- Marwa Bazzi
- Mohamad Hassan Bazzi
- Nader Bazzi
- Rima Bazzi
- Beacon Hospice of Michigan LP
- Tabithia Beavers
- John A Becker
- Madeline M Becker
- Saundra Beden
- Kathryn Petrowski Bedikian
All providers in Canton, MI · Professional Counselor in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.