Provider Demographics
NPI:1932084639
Name:BEACHSIDE THERAPY PLLC
Entity type:Organization
Organization Name:BEACHSIDE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GUILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHCA, NCC
Authorized Official - Phone:252-320-9179
Mailing Address - Street 1:4701 CEDAR LN SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-7533
Mailing Address - Country:US
Mailing Address - Phone:812-820-9019
Mailing Address - Fax:
Practice Address - Street 1:4701 CEDAR LN SW
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-7533
Practice Address - Country:US
Practice Address - Phone:812-820-9019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty