Provider Demographics
NPI:1134728421
Name:BEACH, MARLON (PHD)
Entity type:Individual
Prefix:DR
First Name:MARLON
Middle Name:
Last Name:BEACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 LOXLEY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1470
Mailing Address - Country:US
Mailing Address - Phone:817-683-5082
Mailing Address - Fax:
Practice Address - Street 1:16160 MIDWAY RD STE 218
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4207
Practice Address - Country:US
Practice Address - Phone:469-680-3500
Practice Address - Fax:972-426-8309
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007266103TC0700X
TX38811103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical