Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Beacon St Psychiatry

Organization Psychiatric/Mental Health Nurse Practitioner · NPI 1780460006

Beacon St Psychiatry is a Psychiatric/Mental Health Nurse Practitioner in Centerville, Ohio. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

10552 Success Ln Ste L
Centerville, OH 45458-3664
Phone: (937) 280-5711
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X

Record details

NPI number1780460006
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brad Gibson — Ceo/Owner · (937) 280-5711
Other names A Life Renewed; A Life Renewed
NPI enumeratedSeptember 1, 2023
Last updated in NPPESJanuary 24, 2024
Certification dateJanuary 24, 2024
Mailing address10552 Success Ln Ste L, Centerville, OH 45458-3664

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