Provider Demographics
NPI:1518393735
Name:BEAMAN, CANDY RAE (LAC,CRADC,MARS)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:RAE
Last Name:BEAMAN
Suffix:
Gender:F
Credentials:LAC,CRADC,MARS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N 22ND ST
Mailing Address - Street 2:D-14
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6761
Mailing Address - Country:US
Mailing Address - Phone:479-445-7567
Mailing Address - Fax:
Practice Address - Street 1:4800 N 22ND ST
Practice Address - Street 2:D-14
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6761
Practice Address - Country:US
Practice Address - Phone:479-445-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS696101YA0400X
MO6902101YA0400X
MO7640101YA0400X
MO6460101YA0400X
MO1111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)