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Individual

MARK BRIAN BEATHARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
8623 N. WAYNE ROAD, SUITE 310, ADULT OUTPATIENT SERVICES FOR SMI, WESTLAND, MI 48185
(734) 425-0636
Mailing address
P. O. BOX 79, LINCOLN PARK, MI 48146
(313) 454-7175

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
B363585098663
MI
101YM0800X
Mental Health Counselor

Other

Enumeration date
06/01/2017
Last updated
06/01/2017
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