Provider Demographics
NPI:1770388498
Name:BEATTY, JALYN T
Entity type:Individual
Prefix:
First Name:JALYN
Middle Name:T
Last Name:BEATTY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 HANOVER ST APT I1
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-1731
Mailing Address - Country:US
Mailing Address - Phone:615-987-9476
Mailing Address - Fax:
Practice Address - Street 1:1619 HANOVER ST APT I1
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-1731
Practice Address - Country:US
Practice Address - Phone:615-987-9476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician