Healthcare Provider Details

I. General information

NPI: 1558891457
Provider Name (Legal Business Name): BEATY & BEATY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 HILLCREST AVE
COLUMBIA SC
29203-5657
US

IV. Provider business mailing address

617 HILLCREST AVE
COLUMBIA SC
29203-5657
US

V. Phone/Fax

Practice location:
  • Phone: 803-814-4449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BEATY
Title or Position: OFFICER
Credential: BCBA
Phone: 803-814-4449