Provider Demographics
NPI:1457408841
Name:BEATY, JOHN WESLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:BEATY
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 1:1701 N COLLINS BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3553
Mailing Address - Country:US
Mailing Address - Phone:972-596-6351
Mailing Address - Fax:972-231-4886
Practice Address - Street 1:1701 N COLLINS BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3553
Practice Address - Country:US
Practice Address - Phone:972-596-6351
Practice Address - Fax:972-231-4886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22958103TA0400X, 103TC1900X, 103TF0200X
TX30315103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140051OtherVALUE OPTIONS
TX082142000OtherMAGELLAN HEALTH SERVICES
TX0004225322OtherAETNA BEHAVIORAL HEALTH
TX0004225322OtherAETNA BEHAVIORAL HEALTH
TX00DX56Medicare UPIN