Provider Demographics
NPI:1184165219
Name:BEAVEN, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:BEAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78554
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-0554
Mailing Address - Country:US
Mailing Address - Phone:317-522-0224
Mailing Address - Fax:317-522-0248
Practice Address - Street 1:5151 W 84TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1513
Practice Address - Country:US
Practice Address - Phone:317-522-0224
Practice Address - Fax:317-522-0248
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33007360A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health