Provider Demographics
NPI:1023263480
Name:BEATTY, M.P. TERRINA (MED, LPC, CACIII)
Entity type:Individual
Prefix:
First Name:M.P.
Middle Name:TERRINA
Last Name:BEATTY
Suffix:
Gender:F
Credentials:MED, LPC, CACIII
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:445 E CHEYENNE MOUNTAIN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4560
Mailing Address - Country:US
Mailing Address - Phone:970-314-1663
Mailing Address - Fax:
Practice Address - Street 1:706 CROWN POINT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4872
Practice Address - Country:US
Practice Address - Phone:970-314-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5567101YA0400X
CO2449101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)