Provider Demographics
NPI:1972653020
Name:BEATTY, CHARLES W JR (MA, FAAA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:BEATTY
Suffix:JR
Gender:M
Credentials:MA, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PEGUES PL
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4031
Mailing Address - Country:US
Mailing Address - Phone:903-757-4083
Mailing Address - Fax:903-757-6052
Practice Address - Street 1:1101 PEGUES PL
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4031
Practice Address - Country:US
Practice Address - Phone:903-757-4083
Practice Address - Fax:903-757-6052
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50322231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist