Healthcare Provider Details

I. General information

NPI: 1457408841
Provider Name (Legal Business Name): JOHN WESLEY BEATY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N COLLINS BLVD SUITE 230
RICHARDSON TX
75080-3553
US

IV. Provider business mailing address

1701 N COLLINS BLVD SUITE 230
RICHARDSON TX
75080-3553
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-6351
  • Fax: 972-231-4886
Mailing address:
  • Phone: 972-596-6351
  • Fax: 972-231-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number22958
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number22958
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number22958
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number30315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: