Provider Demographics
NPI:1093198459
Name:BEASLEY, BETH (CJSOC)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:CJSOC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP, CJSOC
Mailing Address - Street 1:3915 N CHADAM LN
Mailing Address - Street 2:APT 1C
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6335
Mailing Address - Country:US
Mailing Address - Phone:317-832-6054
Mailing Address - Fax:
Practice Address - Street 1:3915 N CHADAM LN
Practice Address - Street 2:APT 1C
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6335
Practice Address - Country:US
Practice Address - Phone:317-832-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst