Provider Demographics
NPI:1407330699
Name:BEASLEY, ROBERT LEE (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 RIVE PLACE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2906
Mailing Address - Country:US
Mailing Address - Phone:769-251-5550
Mailing Address - Fax:
Practice Address - Street 1:522 W PARK AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2906
Practice Address - Country:US
Practice Address - Phone:662-374-5029
Practice Address - Fax:662-374-5032
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker