Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 22958 | TX |
Y | 103TC1900X | Counseling Psychologist | 22958 | TX |
N | 103TF0200X | Forensic Psychologist | 22958 | TX |
N | 103TS0200X | School Psychologist | 30315 | TX |
NPI | 1457408841 |
---|---|
Provider Name | Dr. John Wesley Beaty |
First Address | Richardson, TX 75080-3553 |
Second Address | Richardson, TX 75080-3553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004225322 | AETNA BEHAVIORAL HEALTH (01) | TX |
00DX56 | (02) | TX |
082142000 | MAGELLAN HEALTH SERVICES (01) | TX |
140051 | VALUE OPTIONS (01) | TX |