Provider Demographics
NPI:1386195329
Name:BEISNER, PATTI
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:BEISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATII
Other - Middle Name:LORENE
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:438 GLENEAGLES CT
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1221
Mailing Address - Country:US
Mailing Address - Phone:940-781-6689
Mailing Address - Fax:
Practice Address - Street 1:438 GLENEAGLES CT
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1221
Practice Address - Country:US
Practice Address - Phone:940-781-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health