Active NPI
Mark Brian Beathard
- Addiction (Substance Use Disorder) Counselor
- Westland, MI
National Provider Identifier
1336677533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- B363585098663
- Practice address
- 8623 N. Wayne Road, Suite 310
Adult Outpatient Services for Smi
Westland, MI 48185 - Phone
- (734) 425-0636
- NPI assigned
- Jun 1, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | B363585098663 | MI | Primary |
Addresses
Primary practice location
8623 N. Wayne Road, Suite 310
Adult Outpatient Services for Smi
Westland, MI 48185
Mailing address
P. O. Box 79
Lincoln Park, MI 48146
Phone (313) 454-7175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B363585098663 | MI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496275200000",
"number": "1336677533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P. O. BOX 79",
"city": "LINCOLN PARK",
"state": "MI",
"postal_code": "48146",
"telephone_number": "313-454-7175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8623 N. WAYNE ROAD, SUITE 310",
"address_2": "ADULT OUTPATIENT SERVICES FOR SMI",
"city": "WESTLAND",
"state": "MI",
"postal_code": "48185",
"telephone_number": "734-425-0636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEATHARD",
"first_name": "MARK",
"middle_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-01",
"last_updated": "2017-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MI",
"license": "B363585098663",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.