Provider Demographics
NPI:1750449591
Name:BEAM, AUGUSTUS PITT III (PHD)
Entity Type:Individual
Prefix:
First Name:AUGUSTUS
Middle Name:PITT
Last Name:BEAM
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:PITT
Other - Middle Name:
Other - Last Name:BEAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4133 HEDGE HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-1625
Mailing Address - Country:US
Mailing Address - Phone:901-683-8614
Mailing Address - Fax:
Practice Address - Street 1:1835 UNION AVE
Practice Address - Street 2:SUITE315
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3921
Practice Address - Country:US
Practice Address - Phone:901-726-1284
Practice Address - Fax:901-726-4396
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP-1204103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3583104Medicare ID - Type Unspecified