Healthcare Provider Details

I. General information

NPI: 1659808574
Provider Name (Legal Business Name): JAMES BEEDIE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 DIMOND D CIR
ANCHORAGE AK
99515-1931
US

IV. Provider business mailing address

16200 SANDPIPER DR
ANCHORAGE AK
99516-5052
US

V. Phone/Fax

Practice location:
  • Phone: 907-771-0536
  • Fax: 907-771-0537
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110271
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number110271
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: