Healthcare Provider Details

I. General information

NPI: 1639256043
Provider Name (Legal Business Name): BRUCE G MCBEATH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 ENERGY PARK DR
SAINT PAUL MN
55108-5276
US

IV. Provider business mailing address

1687 SIEWERT ST
RED WING MN
55066-2940
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-2267
  • Fax:
Mailing address:
  • Phone: 651-644-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberLP1411
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1411
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLP1411
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: