Healthcare Provider Details

I. General information

NPI: 1306398227
Provider Name (Legal Business Name): WILLIAM PIERCE BEAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 08/14/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9145 GOVERNORS WAY
CINCINNATI OH
45249-2037
US

IV. Provider business mailing address

9145 GOVERNORS WAY
CINCINNATI OH
45249-2037
US

V. Phone/Fax

Practice location:
  • Phone: 513-845-8655
  • Fax: 513-753-9968
Mailing address:
  • Phone: 513-845-8655
  • Fax: 513-753-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number130508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: