Provider Demographics
NPI:1558945394
Name:BEASLEY, KIMBERLY (LMHC,LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LMHC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SUNSET AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2003
Mailing Address - Country:US
Mailing Address - Phone:707-225-7899
Mailing Address - Fax:707-759-3810
Practice Address - Street 1:410 S WARE BLVD STE 844
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4469
Practice Address - Country:US
Practice Address - Phone:813-362-6788
Practice Address - Fax:813-830-7348
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011203101YM0800X
FL20951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health