MEDICARE: MYA CLARK-BEADLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1659261543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYA CLARK-BEADLE

Provider Business Mailing Address
First Line	:	1621 LUTTERLOH RD
Second Line	:
City	:	PITTSBORO
State	:	NC
Zip	:	27312-9296
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10327 US 15 501 N UNIT E
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-6467
Country	:	US
Telephone Number	:	615-560-6622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/03/2025

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Directions to “ MYA CLARK-BEADLE ” Practice Location

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