Provider Demographics
NPI:1598255663
Name:EYDT-BEEBE, MAREIKE ANN
Entity Type:Individual
Prefix:
First Name:MAREIKE
Middle Name:ANN
Last Name:EYDT-BEEBE
Suffix:
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 1:8420 UNIVERSITY EXEC PARK DR STE 810
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1346
Mailing Address - Country:US
Mailing Address - Phone:704-894-9678
Mailing Address - Fax:
Practice Address - Street 1:2100 KRAMER LN STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4094
Practice Address - Country:US
Practice Address - Phone:512-920-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-42064103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst