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General NPI Number Information
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NPI Number | 1275165821
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Entity Type | Individual
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Provider Name | JOHN BEALKE LPC
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Gender | Male
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 102 E NORTH ST
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City | CORTEZ
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State | CO
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Zip | 81321-3227
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Country | US
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Telephone | 970-236-6405
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Fax |
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Provider Business Mailing Address
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Address Line | 27975 ROAD H.6
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City | CORTEZ
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State | CO
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Zip | 81321-9127
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Country | US
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Telephone | 317-946-8311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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