Provider Demographics
NPI:1144354879
Name:BEALL, PAMELA H (LCPC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:H
Last Name:BEALL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N. STATE RTE. L, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970
Mailing Address - Country:US
Mailing Address - Phone:815-432-1024
Mailing Address - Fax:
Practice Address - Street 1:1801 N. STATE ROUTE 1,
Practice Address - Street 2:SUITE 2
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970
Practice Address - Country:US
Practice Address - Phone:815-432-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0003827303OtherBCBS PROVIDER NO.