Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 30427 | NY |
Y | 101YM0800X | Mental Health Counselor | 010481 | NY |
NPI | 1003202052 |
---|---|
Provider Name | Mrs. Kristen Beeles |
First Address | Syracuse, NY 13202-3262 |
Second Address | Syracuse, NY 13202-3262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 29/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01420800 | (05) | NY |