Provider Demographics
NPI:1326524208
Name:BEASLEY FAMILY THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:BEASLEY FAMILY THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-719-0448
Mailing Address - Street 1:1175 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6462
Mailing Address - Country:US
Mailing Address - Phone:734-719-0448
Mailing Address - Fax:
Practice Address - Street 1:124 PEARL ST STE 304
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2663
Practice Address - Country:US
Practice Address - Phone:734-719-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty