Healthcare Provider Details

I. General information

NPI: 1548466121
Provider Name (Legal Business Name): RICHARD DANIEL BEISHLINE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST
DURANT OK
74701-5038
US

IV. Provider business mailing address

3015 KANDE LN
DURANT OK
74701-1667
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-7330
  • Fax:
Mailing address:
  • Phone: 580-916-8565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3853
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: