Provider Demographics
NPI:1437574092
Name:BEASLEY, JEFFREY (AMFT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S KRAEMER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6109
Mailing Address - Country:US
Mailing Address - Phone:562-921-5701
Mailing Address - Fax:562-921-5703
Practice Address - Street 1:101 S KRAEMER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:562-921-5701
Practice Address - Fax:562-921-5703
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF92204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist