Provider Demographics
NPI:1972305381
Name:BEEBOUT, TIERNEY REGAN
Entity type:Individual
Prefix:
First Name:TIERNEY
Middle Name:REGAN
Last Name:BEEBOUT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SAWYER CIR UNIT 824
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8644
Mailing Address - Country:US
Mailing Address - Phone:814-525-8288
Mailing Address - Fax:
Practice Address - Street 1:4900 OHEAR AVE # 24
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5081
Practice Address - Country:US
Practice Address - Phone:843-934-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician