Provider Demographics
NPI:1700245743
Name:BEADLE, PATRICK HENRY (ASW- THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:HENRY
Last Name:BEADLE
Suffix:
Gender:M
Credentials:ASW- THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3218
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93385-3218
Mailing Address - Country:US
Mailing Address - Phone:661-325-1817
Mailing Address - Fax:661-325-3929
Practice Address - Street 1:3117 WILSON RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5319
Practice Address - Country:US
Practice Address - Phone:661-324-4756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0000190519101YA0400X
171M00000X
CAASW1076641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator