Provider Demographics
NPI:1871898338
Name:BEURKENS AUTISM CONSULTING, INC.
Entity type:Organization
Organization Name:BEURKENS AUTISM CONSULTING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEURKENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-698-0306
Mailing Address - Street 1:3120 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9133
Mailing Address - Country:US
Mailing Address - Phone:616-698-0306
Mailing Address - Fax:
Practice Address - Street 1:3120 68TH ST SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9133
Practice Address - Country:US
Practice Address - Phone:616-698-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty