Individual
MRS. NICOLE M BEAGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSW, LLP
Contact information
Practice address
217 E SANILAC RD, SANDUSKY, MI 48471-1383
(810) 648-4327
(810) 648-4338
Mailing address
177 S FULTON ST, SANDUSKY, MI 48471-1345
(810) 648-9249
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013447
MI
104100000X
Social Worker
6802085142
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301013447
LIMTD LICENSE MAST PSYCH.
MI
01
—
6802085142
SOCIAL WORK LICENSE
MI
Enumeration date
10/10/2006
Last updated
03/12/2008
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