Provider Demographics
NPI:1700164191
Name:BEATTY, DAVID P (CADC-M)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:BEATTY
Suffix:
Gender:M
Credentials:CADC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 MICHIGAN AVE
Mailing Address - Street 2:118
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4069
Mailing Address - Country:US
Mailing Address - Phone:517-242-2120
Mailing Address - Fax:
Practice Address - Street 1:1151 MICHIGAN AVE
Practice Address - Street 2:118
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4069
Practice Address - Country:US
Practice Address - Phone:517-242-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI330324171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator