Provider Demographics
NPI:1356570238
Name:BEERS, ANGELA MAY (PSYD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAY
Last Name:BEERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 SYCAMORE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2374
Mailing Address - Country:US
Mailing Address - Phone:269-351-4082
Mailing Address - Fax:
Practice Address - Street 1:423 SYCAMORE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2374
Practice Address - Country:US
Practice Address - Phone:269-351-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014037103T00000X
MI6301016513103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist