Provider Demographics
NPI:1003969106
Name:BEATTY, DEBORAH RUTH (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RUTH
Last Name:BEATTY
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1351
Mailing Address - Country:US
Mailing Address - Phone:630-852-0133
Mailing Address - Fax:
Practice Address - Street 1:2777 FINLEY RD
Practice Address - Street 2:SUITE #1
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1010
Practice Address - Country:US
Practice Address - Phone:630-342-9941
Practice Address - Fax:630-932-7639
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
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
IL02232279OtherBLUE CROSS BLUE SHIELD
229471OtherCOMPSYCH
IL0007871347OtherAETNA BEHAVIORAL HEALTH