Provider Demographics
NPI:1346731189
Name:BEAL, CHRISTIAN STANTON
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:STANTON
Last Name:BEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 MEADOW SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4910
Mailing Address - Country:US
Mailing Address - Phone:217-621-5188
Mailing Address - Fax:
Practice Address - Street 1:3042 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3653
Practice Address - Country:US
Practice Address - Phone:614-487-7805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician