MEDICARE: DR. CRYSTAL LEE BEADLE PH.D.

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	103TS0200X	School Psychologist	34603	TX
2	103G00000X	Clinical Neuropsychologist	34764	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871953273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL LEE BEADLE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 845
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-0015
Country	:	US
Telephone Number	:	469-731-5440
Fax Number	:	469-731-5537

Provider Business Practice Location Address
First Line	:	7552 MAIN ST
Second Line	:	BLDG B
City	:	THE COLONY
State	:	TX
Zip	:	75056-3448
Country	:	US
Telephone Number	:	469-731-5440
Fax Number	:	469-731-5537

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

Provider Enumeration Date	:	02/26/2016
Last Update Date	:	06/07/2018

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