Provider Demographics
NPI:1205263472
Name:BEEBE, DEBRA SUE (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUE
Last Name:BEEBE
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1325 ASHTON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5091
Mailing Address - Country:US
Mailing Address - Phone:269-553-7090
Mailing Address - Fax:269-553-7129
Practice Address - Street 1:418 W KALAMAZOO AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3334
Practice Address - Country:US
Practice Address - Phone:269-553-7090
Practice Address - Fax:269-553-7129
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301007078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3313413Medicaid