Provider Demographics
NPI:1124539598
Name:JONATHAN M BEYER
Entity Type:Organization
Organization Name:JONATHAN M BEYER
Other - Org Name:JONATHAN BEYER PHD LP & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:218-722-4880
Mailing Address - Street 1:324 W SUPERIOR ST STE 505
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1725
Mailing Address - Country:US
Mailing Address - Phone:218-722-4880
Mailing Address - Fax:218-722-4662
Practice Address - Street 1:324 W SUPERIOR ST STE 505
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1725
Practice Address - Country:US
Practice Address - Phone:218-722-4880
Practice Address - Fax:218-722-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty