Provider Demographics
NPI:1558043828
Name:DONAHUE, BEAU RYAN
Entity Type:Individual
Prefix:MR
First Name:BEAU
Middle Name:RYAN
Last Name:DONAHUE
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 1:2208 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9684
Mailing Address - Country:US
Mailing Address - Phone:615-440-7428
Mailing Address - Fax:
Practice Address - Street 1:2208 N VALLEY DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-9684
Practice Address - Country:US
Practice Address - Phone:615-440-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51381101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)