Provider Demographics
NPI:1275165821
Name:BEALKE, JOHN (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BEALKE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27975 ROAD H.6
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-9127
Mailing Address - Country:US
Mailing Address - Phone:317-946-8311
Mailing Address - Fax:
Practice Address - Street 1:102 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3227
Practice Address - Country:US
Practice Address - Phone:970-236-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional