Provider Demographics
NPI:1376691618
Name:BEATTIE, JANICE DARLENE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:DARLENE
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8975
Mailing Address - Country:US
Mailing Address - Phone:425-369-2332
Mailing Address - Fax:
Practice Address - Street 1:1495 NW GILMAN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8975
Practice Address - Country:US
Practice Address - Phone:425-369-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health