Healthcare Provider Details

I. General information

NPI: 1144599838
Provider Name (Legal Business Name): JIMMIE DARREN BEIRNE M.A., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2011
Last Update Date: 12/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 BOULEVARD AVE
HUNTINGTON WV
25701-3604
US

IV. Provider business mailing address

1424 BOULEVARD AVE
HUNTINGTON WV
25701-3604
US

V. Phone/Fax

Practice location:
  • Phone: 304-412-1719
  • Fax:
Mailing address:
  • Phone: 304-412-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5714
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: