Provider Demographics
NPI:1689830283
Name:BEAVEN, AMY E (MS, APA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:BEAVEN
Suffix:
Gender:F
Credentials:MS, APA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17707 DARDEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1111
Mailing Address - Country:US
Mailing Address - Phone:574-850-4416
Mailing Address - Fax:574-850-4416
Practice Address - Street 1:17707 DARDEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1111
Practice Address - Country:US
Practice Address - Phone:574-850-4416
Practice Address - Fax:574-850-4416
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral