Provider Demographics
NPI:1144599838
Name:BEIRNE, JIMMIE DARREN (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:DARREN
Last Name:BEIRNE
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3604
Mailing Address - Country:US
Mailing Address - Phone:304-412-1719
Mailing Address - Fax:
Practice Address - Street 1:1424 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3604
Practice Address - Country:US
Practice Address - Phone:304-412-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-09-5714103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst