Provider Demographics
NPI:1568282812
Name:BEACON PSYCHIATRY AND MENTAL WELLNESS, PLLC
Entity type:Organization
Organization Name:BEACON PSYCHIATRY AND MENTAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HEIDELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:830-264-8210
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-0122
Mailing Address - Country:US
Mailing Address - Phone:830-264-8210
Mailing Address - Fax:
Practice Address - Street 1:1600 S FM 2381
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1900
Practice Address - Country:US
Practice Address - Phone:830-264-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty