Provider Demographics
NPI:1578861902
Name:BEASLEY, CRAIG ANTHONY
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 NW 161ST ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3208
Mailing Address - Country:US
Mailing Address - Phone:405-823-2319
Mailing Address - Fax:
Practice Address - Street 1:4900 NW 161ST ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3208
Practice Address - Country:US
Practice Address - Phone:405-823-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst