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General NPI Number Information
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NPI Number | 1639256043
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Entity Type | Individual
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Provider Name | BRUCE G MCBEATH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1360 ENERGY PARK DR
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City | SAINT PAUL
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State | MN
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Zip | 55108-5276
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Country | US
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Telephone | 651-644-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 1687 SIEWERT ST
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City | RED WING
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State | MN
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Zip | 55066-2940
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Country | US
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Telephone | 651-644-2267
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | LP1411
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP1411
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | LP1411
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License Number State | MN
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