Provider Demographics
NPI:1679845952
Name:BEY, JEAN ELLEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ELLEN
Last Name:BEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 NW 27TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6683
Mailing Address - Country:US
Mailing Address - Phone:352-318-9766
Mailing Address - Fax:386-754-7391
Practice Address - Street 1:618 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5841
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-754-7391
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9551101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health