Provider Demographics
NPI:1821650938
Name:BEASLEY, STUART MARTIN (CO60961854)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:MARTIN
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:CO60961854
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 MAHOGANY LN NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8905
Mailing Address - Country:US
Mailing Address - Phone:360-620-9505
Mailing Address - Fax:
Practice Address - Street 1:1415 LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9179
Practice Address - Country:US
Practice Address - Phone:360-876-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60961854101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)