Provider Demographics
NPI:1083184550
Name:BEATTEY, ROBERT A JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:BEATTEY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22351
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-0351
Mailing Address - Country:US
Mailing Address - Phone:800-499-7105
Mailing Address - Fax:
Practice Address - Street 1:910 10TH AVE E APT 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4556
Practice Address - Country:US
Practice Address - Phone:714-421-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-004928103T00000X
WAPY60888285103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist