Provider Demographics
NPI:1417904269
Name:BEAL COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:BEAL COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:R JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:BCD LCSW
Authorized Official - Phone:814-444-9696
Mailing Address - Street 1:445 WESTRIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1148
Mailing Address - Country:US
Mailing Address - Phone:814-444-9696
Mailing Address - Fax:814-444-0345
Practice Address - Street 1:445 WESTRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1148
Practice Address - Country:US
Practice Address - Phone:814-444-9696
Practice Address - Fax:814-444-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA567-012101YA0400X
PACW0126831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01435492OtherHIGHMARK
PA1011556830002Medicaid