Provider Demographics
NPI:1043470156
Name:BEASLEY PREFFER, JENNIFER L (LMHC, NCC, ACS, RN)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:BEASLEY PREFFER
Suffix:
Gender:F
Credentials:LMHC, NCC, ACS, RN
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:PREFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, NCC, ACS, RN
Mailing Address - Street 1:2950 HALCYON LN
Mailing Address - Street 2:SUITE 703
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6689
Mailing Address - Country:US
Mailing Address - Phone:904-701-8255
Mailing Address - Fax:
Practice Address - Street 1:2950 HALCYON LN
Practice Address - Street 2:SUITE 703
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6689
Practice Address - Country:US
Practice Address - Phone:904-701-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9062101YM0800X
FLRN9278982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse