Provider Demographics
NPI:1801634720
Name:BLUE BEACON MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:BLUE BEACON MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUPO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:315-730-7271
Mailing Address - Street 1:4 CLYMER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4710
Mailing Address - Country:US
Mailing Address - Phone:315-730-7271
Mailing Address - Fax:315-975-6604
Practice Address - Street 1:4 CLYMER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4710
Practice Address - Country:US
Practice Address - Phone:315-730-7271
Practice Address - Fax:315-975-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty