Provider Demographics
NPI:1851455869
Name:BEYER, JONATHAN MCKAY (PHD, LP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MCKAY
Last Name:BEYER
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3932 W PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-9341
Mailing Address - Country:US
Mailing Address - Phone:218-310-4801
Mailing Address - Fax:
Practice Address - Street 1:3932 W PIONEER RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-9341
Practice Address - Country:US
Practice Address - Phone:218-310-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1430103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist