Basic Information
| Provider Information | |||||||||
| NPI: | 1629065412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEERY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIT 28747 BOX 6537 | ||||||||
| Address2: | |||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 091778747 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | U.S. ARMY HEALTH CLINIC ANSBACH | ||||||||
| Address2: | BLDG 5186 CHEYENNE AVENUE | ||||||||
| City: | ANSBACH | ||||||||
| State: | GERMANY | ||||||||
| PostalCode: | 09623 | ||||||||
| CountryCode: | DE | ||||||||
| TelephoneNumber: | 1111111111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 745 | AL | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC0700X | 5949857-2501 | UT | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | 5949857-2501 | UT | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.