Provider Demographics
NPI:1588030522
Name:BEESLEY, JEFF (MS)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:BEESLEY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 CROOKEN RIVER CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2834
Mailing Address - Country:US
Mailing Address - Phone:916-342-4818
Mailing Address - Fax:
Practice Address - Street 1:1780 VERNON ST STE 1
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6311
Practice Address - Country:US
Practice Address - Phone:916-342-4818
Practice Address - Fax:916-782-4544
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105525106H00000X
CAIMF#87741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist