Healthcare Provider Details

I. General information

NPI: 1689291569
Provider Name (Legal Business Name): MISS ALEXANDRIA NICHOLE BEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ALEXANDRIA BEELER

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 3RD AVE
SPOKANE WA
99202-6014
US

IV. Provider business mailing address

701 E 3RD AVE
SPOKANE WA
99202-6014
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-6092
  • Fax:
Mailing address:
  • Phone: 509-838-6092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number61059215
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: