Provider Demographics
NPI:1508144668
Name:BEIJAN, KEVAN S (MED, LPC-S)
Entity Type:Individual
Prefix:MR
First Name:KEVAN
Middle Name:S
Last Name:BEIJAN
Suffix:
Gender:M
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3007
Mailing Address - Country:US
Mailing Address - Phone:972-580-8500
Mailing Address - Fax:972-255-3162
Practice Address - Street 1:1320 W WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3007
Practice Address - Country:US
Practice Address - Phone:972-580-8500
Practice Address - Fax:972-255-3162
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional