Provider Demographics
NPI:1558705897
Name:BEAZEL, CAROL A (PHD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BEAZEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 NEWARK RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2618
Mailing Address - Country:US
Mailing Address - Phone:740-454-0738
Mailing Address - Fax:740-454-1162
Practice Address - Street 1:1175 NEWARK RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2618
Practice Address - Country:US
Practice Address - Phone:740-454-0738
Practice Address - Fax:740-454-1162
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0001930- S101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional