Provider Demographics
NPI:1366578601
Name:BEACH, KENDRA (LPCC-S)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-0276
Mailing Address - Fax:330-759-0030
Practice Address - Street 1:378 N HIGH ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1023
Practice Address - Country:US
Practice Address - Phone:330-637-8668
Practice Address - Fax:330-637-1239
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC. 0500171101YM0800X
OHE.0500171-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health