Provider Demographics
NPI:1568734168
Name:BEAL, JANICE M (PH D)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:BEAL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S LOOP W
Mailing Address - Street 2:SUITE 562
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2653
Mailing Address - Country:US
Mailing Address - Phone:713-337-2457
Mailing Address - Fax:713-337-2458
Practice Address - Street 1:2600 S LOOP W
Practice Address - Street 2:SUITE 562
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2653
Practice Address - Country:US
Practice Address - Phone:713-337-2457
Practice Address - Fax:713-337-2458
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025687701Medicaid