Provider Demographics
NPI:1922540368
Name:BEAMAN, BRUCE A (LMFT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BEAMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HIGHWAY 73
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-9452
Mailing Address - Country:US
Mailing Address - Phone:218-565-6055
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9452
Practice Address - Country:US
Practice Address - Phone:218-565-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist