Provider Demographics
NPI:1588734560
Name:BEATTIE, DOUGLAS G (LMFT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:BEATTIE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 PIERCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5305
Mailing Address - Country:US
Mailing Address - Phone:607-754-2823
Mailing Address - Fax:
Practice Address - Street 1:193 PIERCE HILL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-5305
Practice Address - Country:US
Practice Address - Phone:607-754-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE135685OtherCDPHP VALUE OPTIONS