Provider Demographics
NPI:1366614844
Name:BEYER, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BEYER
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 1:95 E HIGH ST
Mailing Address - Street 2:SUITE 342
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1853
Mailing Address - Country:US
Mailing Address - Phone:877-472-9466
Mailing Address - Fax:800-398-6217
Practice Address - Street 1:95 E HIGH ST
Practice Address - Street 2:SUITE 342
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1853
Practice Address - Country:US
Practice Address - Phone:877-472-9466
Practice Address - Fax:800-398-6217
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW123536OtherPA STATE LICENSE