Provider Demographics
NPI:1649558339
Name:BEESON, ISABELLA C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:C
Last Name:BEESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAYBERRY
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-2206
Mailing Address - Country:US
Mailing Address - Phone:417-619-3934
Mailing Address - Fax:
Practice Address - Street 1:550 MAYBERRY
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-2206
Practice Address - Country:US
Practice Address - Phone:417-619-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional