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General NPI Number Information
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NPI Number | 1982386751
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Entity Type | Individual
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Provider Name | ROBERT BEEDLE PHD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3903 INDIANAPOLIS BLVD
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2555
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Country | US
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Telephone | 219-769-4005
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Fax | 219-937-5808
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Provider Business Mailing Address
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Address Line | 3903 INDIANAPOLIS BLVD
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2555
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Country | US
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Telephone | 219-769-4005
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Fax | 219-937-5808
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20043875A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20053875B
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License Number State | IN
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