Provider Demographics
NPI:1518086974
Name:BEASLEY, PERCY E (BEHAVIOR ANALYST)
Entity Type:Individual
Prefix:MR
First Name:PERCY
Middle Name:E
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:BEHAVIOR ANALYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEEKS ST APT A1
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-4341
Mailing Address - Country:US
Mailing Address - Phone:731-325-9303
Mailing Address - Fax:
Practice Address - Street 1:1401 MEEKS ST APT A1
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-4341
Practice Address - Country:US
Practice Address - Phone:731-325-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE1429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty