Provider Demographics
NPI:1457601049
Name:BEYER, MICHAEL A
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:BEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 LAKESIDE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5774
Mailing Address - Country:US
Mailing Address - Phone:510-262-6551
Mailing Address - Fax:
Practice Address - Street 1:4175 LAKESIDE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5774
Practice Address - Country:US
Practice Address - Phone:510-262-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245393503Medicaid