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General NPI Number Information
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NPI Number | 1902135486
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Entity Type | Organization
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Legal Business Name | BEALL & ASSOCIATES INC.
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 961687 GATEWAY BLVD SUITE 201 N
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-9157
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Country | US
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Telephone | 904-277-8999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16837
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City | FERNANDINA BEACH
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State | FL
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Zip | 32035-3131
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Country | US
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Telephone | 904-556-2169
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Fax | 904-206-4174
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BYRON FRANK BEALL
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Credential | LCSW. BCBA
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Telephone | 904-556-2169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BCBA 1010451
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW 5260
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License Number State | FL
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