Provider Demographics
NPI:1538109871
Name:BEECHAM, WILLIAM MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:BEECHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4675 GREENTREE PL
Mailing Address - Street 2:APT. A
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4181
Mailing Address - Country:US
Mailing Address - Phone:561-393-0360
Mailing Address - Fax:561-391-9628
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 114
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-393-0360
Practice Address - Fax:561-391-9628
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY4109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73492Medicare ID - Type UnspecifiedPSYCHOLOGIST