Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 12631 | TN |
N | 104100000X | Social Worker | 63033 | TX |
NPI | 1003467598 |
---|---|
Provider Name | Anne Rareshide Beach |
First Address | Clarksville, TN 37042-6395 |
Second Address | Clarksville, TN 37040-5257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2019 |
Last Update Date | 25/09/2019 |