Active NPI
Ryan Gordon Beale, MA, TLLP
- Clinical Psychologist
- Pontiac, MI
National Provider Identifier
1538533815
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301016481
- Practice address
- 1200 N Telegraph Rd
Building 32 East
Pontiac, MI 48341-1032 - Phone
- (248) 451-2600
- NPI assigned
- Nov 24, 2015
- Last updated
- Nov 24, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301016481 | MI | Primary |
Addresses
Primary practice location
1200 N Telegraph Rd
Building 32 East
Pontiac, MI 48341-1032
Mailing address
13343 Nadine Ave
Huntington Woods, MI 48070-1422
Phone (312) 543-1333
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301016481 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448323200000",
"number": "1538533815",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13343 NADINE AVE",
"city": "HUNTINGTON WOODS",
"state": "MI",
"postal_code": "480701422",
"telephone_number": "312-543-1333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N TELEGRAPH RD",
"address_2": "BUILDING 32 EAST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483411032",
"telephone_number": "248-451-2600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEALE",
"first_name": "RYAN",
"middle_name": "GORDON",
"credential": "MA, TLLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-24",
"last_updated": "2015-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301016481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.