Provider Demographics
NPI:1700203155
Name:BEASON, TERRANCE LEON (MED, CAGS)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:LEON
Last Name:BEASON
Suffix:
Gender:M
Credentials:MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 LANIER PL NW APT 408
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2941
Mailing Address - Country:US
Mailing Address - Phone:202-329-1517
Mailing Address - Fax:
Practice Address - Street 1:1660 LANIER PLACE #408
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-329-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool