Provider Demographics
NPI:1669645610
Name:BEASLEY, PEGGY L (LPC, MHSP)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:L
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 WARD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-0560
Mailing Address - Country:US
Mailing Address - Phone:615-895-6942
Mailing Address - Fax:615-867-6314
Practice Address - Street 1:1810 WARD DR STE 103
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0560
Practice Address - Country:US
Practice Address - Phone:615-895-6942
Practice Address - Fax:615-867-6314
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1914101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4172786OtherBCBS