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General NPI Number Information
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NPI Number | 1790985364
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Entity Type | Individual
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Provider Name | MARK CHANDLER BEAL M.S.W., L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 2150 ACADEMY CIR SUITE C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1693
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Country | US
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Telephone | 719-338-3537
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Fax | 719-358-8248
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Provider Business Mailing Address
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Address Line | 2150 ACADEMY CIR SUITE C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1693
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Country | US
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Telephone | 719-338-3537
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Fax | 719-358-8248
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW
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License Number State | CO
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