Provider Demographics
NPI:1063993194
Name:BEAYRD, KRYSTAL GAIL (RADT-I)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:GAIL
Last Name:BEAYRD
Suffix:
Gender:F
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6024
Mailing Address - Country:US
Mailing Address - Phone:559-625-0440
Mailing Address - Fax:559-625-0460
Practice Address - Street 1:212 N STEVENSON ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6024
Practice Address - Country:US
Practice Address - Phone:559-625-0440
Practice Address - Fax:559-625-0460
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1310610618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty