Provider Demographics
NPI:1518926476
Name:BEEBE, RONALD J (PSYD HSPP)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:BEEBE
Suffix:
Gender:M
Credentials:PSYD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SOUTH INDIANA STREET
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1648
Mailing Address - Country:US
Mailing Address - Phone:317-371-1681
Mailing Address - Fax:317-831-2686
Practice Address - Street 1:3170 AUTUMN RUN
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8369
Practice Address - Country:US
Practice Address - Phone:317-371-1681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042164A103TC0700X
IN35001531A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200933720Medicaid
IN150074Medicare PIN