Provider Demographics
NPI:1790985364
Name:BEAL, MARK CHANDLER (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHANDLER
Last Name:BEAL
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Gender:M
Credentials:MSW, LCSW
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Mailing Address - Street 1:2150 ACADEMY CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1693
Mailing Address - Country:US
Mailing Address - Phone:719-338-3537
Mailing Address - Fax:719-358-8248
Practice Address - Street 1:2150 ACADEMY CIR
Practice Address - Street 2:SUITE C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1693
Practice Address - Country:US
Practice Address - Phone:719-338-3537
Practice Address - Fax:719-358-8248
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2012-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COLCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO638171Medicaid