=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942976667
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BEATTEY GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2021
-----------------------------------------------------
Last Update Date | 08/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12844 MILITARY RD S
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98168-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-499-7105
-----------------------------------------------------
Fax | 206-333-0603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 22351
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-0351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-499-7105
-----------------------------------------------------
Fax | 206-333-0603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DR. ROBERT A BEATTEY
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 800-499-7105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------