Provider Demographics
NPI:1932605078
Name:BEACHAM, XZAVIER MARQUEZE
Entity Type:Individual
Prefix:
First Name:XZAVIER
Middle Name:MARQUEZE
Last Name:BEACHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12344 NW BARNES RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6063
Mailing Address - Country:US
Mailing Address - Phone:817-715-5443
Mailing Address - Fax:
Practice Address - Street 1:8915 SW CENTER ST. TIGARD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-726-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health