Provider Demographics
NPI:1447989157
Name:BEAUCHAMP, LILIAN
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:
Other - Last Name:BEAUCHAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1801 WATERMARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7088
Mailing Address - Country:US
Mailing Address - Phone:614-438-3400
Mailing Address - Fax:
Practice Address - Street 1:6993 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8411
Practice Address - Country:US
Practice Address - Phone:941-780-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW170671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical