Provider Demographics
NPI:1417174152
Name:BEAN, ROY A (PH D)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:A
Last Name:BEAN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 NORTH 900 EAST
Mailing Address - Street 2:258 TLRB
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84602
Mailing Address - Country:US
Mailing Address - Phone:801-422-2349
Mailing Address - Fax:801-422-0163
Practice Address - Street 1:1190 NORTH 900 EAST
Practice Address - Street 2:258 TLRB
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602
Practice Address - Country:US
Practice Address - Phone:801-422-2349
Practice Address - Fax:801-422-0163
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328238-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist