Bruce A. Beaman, LMFT
Individual provider Active NPI Marriage & Family Therapist · Moose Lake, MN
NPI 1922540368 · NPPES record last updated Nov 16, 2016
Key facts
- NPI
- 1922540368
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 1548 (MN)
- Practice address
- 1111 Highway 73
Moose Lake, MN 55767-9452 - Phone
- (218) 565-6055
- NPI assigned
- Nov 16, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 8, 2024 through Mar 8, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1548 | MN | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 1548 | MN | Yes |
Addresses
Primary practice location
1111 Highway 73
Moose Lake, MN 55767-9452
Mailing address
1111 Highway 73
Moose Lake, MN 55767-9452
Phone (218) 565-6055
NPI Registry JSON
{
"created_epoch": "1479254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479254400000",
"number": "1922540368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 HIGHWAY 73",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "557679452",
"telephone_number": "218-565-6055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 HIGHWAY 73",
"city": "MOOSE LAKE",
"state": "MN",
"postal_code": "557679452",
"telephone_number": "218-565-6055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAMAN",
"first_name": "BRUCE",
"middle_name": "A.",
"credential": "LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-16",
"last_updated": "2016-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "1548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moose Lake, MN
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- Augustana Oakview Care, LLC
- Kristina Bailey
- Sharyn Barney
- John Sutherland Barry
- Brianna D Bentley
- Josie Benzie
- Kathy H. Brandli
- Blake Steven Chapman
- Luann Joyce Charboneau
All providers in Moose Lake, MN · Marriage & Family Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.