Provider Demographics
NPI:1447393806
Name:BEAL, ROBERT (PHD LP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BEAL
Suffix:
Gender:M
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38257 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-2102
Mailing Address - Country:US
Mailing Address - Phone:218-927-4127
Mailing Address - Fax:218-927-4127
Practice Address - Street 1:38257 DOVE ST
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-2102
Practice Address - Country:US
Practice Address - Phone:218-927-4127
Practice Address - Fax:218-927-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45060BEOtherPROVIDER FOR BLUE CROSS