Provider Demographics
NPI:1093850984
Name:BEAVER, CHAD HUNTER (MED)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:HUNTER
Last Name:BEAVER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 KEY PENINSULA HWY N
Mailing Address - Street 2:
Mailing Address - City:LAKEBAY
Mailing Address - State:WA
Mailing Address - Zip Code:98349-9326
Mailing Address - Country:US
Mailing Address - Phone:253-884-3644
Mailing Address - Fax:
Practice Address - Street 1:8309 KEY PENINSULA HWY N
Practice Address - Street 2:
Practice Address - City:LAKEBAY
Practice Address - State:WA
Practice Address - Zip Code:98349-9326
Practice Address - Country:US
Practice Address - Phone:253-884-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51539220OtherBCBS