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General NPI Number Information
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NPI Number | 1881364180
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Entity Type | Individual
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Provider Name | OCTAVIA BEYAH
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Gender | Female
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 4865 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3508
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Country | US
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Telephone | 610-532-7810
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N 16TH ST APT 1822
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City | PHILADELPHIA
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State | PA
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Zip | 19102-1211
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Country | US
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Telephone | 215-300-1766
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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