Provider Demographics
NPI:1902135486
Name:BEALL & ASSOCIATES INC.
Entity Type:Organization
Organization Name:BEALL & ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BEALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW BCBA
Authorized Official - Phone:904-556-2169
Mailing Address - Street 1:PO BOX 16837
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3131
Mailing Address - Country:US
Mailing Address - Phone:904-556-2169
Mailing Address - Fax:904-206-4174
Practice Address - Street 1:961687 GATEWAY BLVD
Practice Address - Street 2:SUITE 201 N
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-9157
Practice Address - Country:US
Practice Address - Phone:904-277-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 5260251S00000X
FLBCBA 1010451251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692499996Medicaid
FL692499998Medicaid