Provider Demographics
NPI:1184604753
Name:BEALL, SUSAN (BSSW MSW ACSW LISW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BEALL
Suffix:
Gender:F
Credentials:BSSW MSW ACSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 W RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6424
Mailing Address - Country:US
Mailing Address - Phone:937-296-1007
Mailing Address - Fax:937-395-0607
Practice Address - Street 1:1250 W DOROTHY LN
Practice Address - Street 2:STE 210
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1317
Practice Address - Country:US
Practice Address - Phone:937-296-1007
Practice Address - Fax:937-395-0607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0005030101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH62-09745OtherUNITED BEHAVIORAL HEALTH
OH7979584OtherAETNA
OH000000274795OtherANTHEM
OHSW29491Medicare ID - Type Unspecified