Provider Demographics
NPI:1548391923
Name:BEALS, PAUL HENDERSON
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HENDERSON
Last Name:BEALS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 PEARSON CT.
Mailing Address - Street 2:P.O.BOX 310
Mailing Address - City:ESTER
Mailing Address - State:AK
Mailing Address - Zip Code:99725-0310
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:
Practice Address - Street 1:201 1ST AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4848
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health