Provider Demographics
NPI:1447898838
Name:BEAUCHAMP, ELLIOTT REMOND (BACHELOR OF SCIENCE)
Entity type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:REMOND
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14582 W DAVID DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1201
Mailing Address - Country:US
Mailing Address - Phone:601-807-2378
Mailing Address - Fax:
Practice Address - Street 1:6685 SULLIVAN RD STE B
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3112
Practice Address - Country:US
Practice Address - Phone:225-261-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician