MEDICARE: TIERNEY REGAN BEEBOUT

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	:	1972305381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERNEY REGAN BEEBOUT

Provider Business Mailing Address
First Line	:	219 SAWYER CIR UNIT 824
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8644
Country	:	US
Telephone Number	:	814-525-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 OHEAR AVE # 24
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5081
Country	:	US
Telephone Number	:	843-934-7575
Fax Number	:

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

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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Directions to “ TIERNEY REGAN BEEBOUT ” Practice Location

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