Provider Demographics
NPI:1568055002
Name:BHATTARAI, BEDA MAYA JR
Entity Type:Individual
Prefix:
First Name:BEDA
Middle Name:MAYA
Last Name:BHATTARAI
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 BURDICK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2652
Mailing Address - Country:US
Mailing Address - Phone:701-314-9652
Mailing Address - Fax:
Practice Address - Street 1:476 BURDICK CT
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2652
Practice Address - Country:US
Practice Address - Phone:701-314-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDBHA-91-6584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health