Provider Demographics
NPI:1710257563
Name:BEASLEY, TALISA (LPC)
Entity Type:Individual
Prefix:
First Name:TALISA
Middle Name:
Last Name:BEASLEY
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 1:3996 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4938
Mailing Address - Country:US
Mailing Address - Phone:404-849-7544
Mailing Address - Fax:
Practice Address - Street 1:3996 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4938
Practice Address - Country:US
Practice Address - Phone:404-849-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health