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General NPI Number Information
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NPI Number | 1417904269
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Entity Type | Organization
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Legal Business Name | BEAL COUNSELING & CONSULTING
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 445 WESTRIDGE RD SUITE 103
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City | SOMERSET
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State | PA
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Zip | 15501-1148
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Country | US
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Telephone | 814-444-9696
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Fax | 814-444-0345
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Provider Business Mailing Address
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Address Line | 445 WESTRIDGE RD SUITE 103
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City | SOMERSET
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State | PA
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Zip | 15501-1148
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Country | US
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Telephone | 814-444-9696
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Fax | 814-444-0345
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MR. R JUSTIN BEAL
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Credential | BCD LCSW
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Telephone | 814-444-9696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW012683
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 567-012
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License Number State | PA
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