Provider Demographics
NPI:1760401525
Name:BEEBE, JESSE RAY (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:RAY
Last Name:BEEBE
Suffix:
Gender:M
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:P.O. BOX 457
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84089-0457
Mailing Address - Country:US
Mailing Address - Phone:801-825-4535
Mailing Address - Fax:801-825-8281
Practice Address - Street 1:4617 S PIONEER RD STE 101D
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5156
Practice Address - Country:US
Practice Address - Phone:801-872-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
UT4925843-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker