Healthcare Provider Details

I. General information

NPI: 1184604753
Provider Name (Legal Business Name): SUSAN BEALL BSSW MSW ACSW LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W DOROTHY LN STE 210
DAYTON OH
45409-1317
US

IV. Provider business mailing address

922 W RIVERVIEW AVE
DAYTON OH
45402-6424
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-1007
  • Fax: 937-395-0607
Mailing address:
  • Phone: 937-296-1007
  • Fax: 937-395-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI-0005030
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-0005030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: