Provider Demographics
NPI:1700933116
Name:JOHN W. BEATY, PH.D.,P.C.
Entity Type:Organization
Organization Name:JOHN W. BEATY, PH.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-596-6351
Mailing Address - Street 1:1701 N COLLINS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3564
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 210
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3564
Practice Address - Country:US
Practice Address - Phone:972-596-6351
Practice Address - Fax:972-231-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22958103TA0400X, 103TA0700X, 103TC1900X, 103TC2200X, 103TF0200X
TX30315103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004225322OtherAETNA BEHAVIORAL HEALTH
TX140051OtherVALUE OPTIONS
TX00DX56Medicare ID - Type Unspecified
TX0004225322OtherAETNA BEHAVIORAL HEALTH