Healthcare Provider Details

I. General information

NPI: 1700677911
Provider Name (Legal Business Name): SYDNEY NICOLE BEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAVEN NICOLE BEAL

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 OHIO PIKE STE 102-B
CINCINNATI OH
45255-3721
US

IV. Provider business mailing address

10632 TONYA DR
WALTON KY
41094-9708
US

V. Phone/Fax

Practice location:
  • Phone: 888-830-0347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: