Provider Demographics
NPI:1346462363
Name:BEATTY, EVA LOU (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVA LOU
Middle Name:
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2205
Mailing Address - Country:US
Mailing Address - Phone:435-260-2324
Mailing Address - Fax:
Practice Address - Street 1:115 W 200 S # 7
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2534
Practice Address - Country:US
Practice Address - Phone:435-260-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT135145-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical