Provider Demographics
NPI:1134698087
Name:BEATHEA, NATASHA MARIE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:BEATHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N TACOMA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3548
Mailing Address - Country:US
Mailing Address - Phone:317-209-7970
Mailing Address - Fax:
Practice Address - Street 1:5555 N TACOMA AVE STE 2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3548
Practice Address - Country:US
Practice Address - Phone:317-209-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health