=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376864751
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. TIMOTHY A BEAUPARLANT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2010
-----------------------------------------------------
Last Update Date | 06/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 JUNGERMANN RD SUITE 102
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-2775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-795-1233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 CANTERBURY DR
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-795-1233
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 000851
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------