Healthcare Provider Details

I. General information

NPI: 1760565055
Provider Name (Legal Business Name): CAROL JOANN BEATHEA PHD LCSW MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: C JOANN BEATHEA PHD MSW LCSW

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W LEXINGTON AVE SUITE 206
ELKHART IN
46516
US

IV. Provider business mailing address

330 W LEXINGTON AVE SUITE 206
ELKHART IN
46516
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-5991
  • Fax: 574-293-5429
Mailing address:
  • Phone: 574-293-5991
  • Fax: 574-293-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34000509A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number34000509A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: