Provider Demographics
NPI:1154145423
Name:BEALL, MIRIAM
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BEALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, COMS
Mailing Address - Street 1:3136 DOUBLE CAMP RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WV
Mailing Address - Zip Code:26426-5128
Mailing Address - Country:US
Mailing Address - Phone:304-991-3120
Mailing Address - Fax:304-782-2437
Practice Address - Street 1:3136 DOUBLE CAMP RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WV
Practice Address - Zip Code:26426-5128
Practice Address - Country:US
Practice Address - Phone:304-991-3120
Practice Address - Fax:304-782-2437
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV478332252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency