Provider Demographics
NPI:1801891742
Name:BEATY, WILLIAM E (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:BEATY
Suffix:
Gender:M
Credentials:PHD
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 357703
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7703
Mailing Address - Country:US
Mailing Address - Phone:352-331-5520
Mailing Address - Fax:352-331-6323
Practice Address - Street 1:5214 SW 91ST WAY
Practice Address - Street 2:#120
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4172
Practice Address - Country:US
Practice Address - Phone:352-331-5520
Practice Address - Fax:352-331-6323
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-10-13
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FLPY0003468103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75549OtherBLUE CROSS