Provider Demographics
NPI:1073228698
Name:JOSEPH BEENEY PH D PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:JOSEPH BEENEY PH D PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-972-5089
Mailing Address - Street 1:720 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3125
Mailing Address - Country:US
Mailing Address - Phone:707-421-8884
Mailing Address - Fax:
Practice Address - Street 1:650 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3220
Practice Address - Country:US
Practice Address - Phone:707-421-8884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health