Provider Demographics
NPI:1790441012
Name:BEALL, CHRISTIAN MATTHEW
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:MATTHEW
Last Name:BEALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 GRASS VALLEY HWY SPC 252
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2036
Mailing Address - Country:US
Mailing Address - Phone:530-887-8220
Mailing Address - Fax:
Practice Address - Street 1:760 S AUBURN ST STE C
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4318
Practice Address - Country:US
Practice Address - Phone:530-270-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB7378614OtherDRIVERS LICENSE