Provider Demographics
NPI:1700281136
Name:BEATY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BEATY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N JOSEY LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3157
Mailing Address - Country:US
Mailing Address - Phone:720-213-8230
Mailing Address - Fax:469-575-3002
Practice Address - Street 1:5025 COLLINGSWOOD CT
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-6894
Practice Address - Country:US
Practice Address - Phone:720-213-8230
Practice Address - Fax:469-575-3002
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-10060103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst