Provider Demographics
NPI:1891167623
Name:JEANNIE K BEAUSHAW, LLC
Entity Type:Organization
Organization Name:JEANNIE K BEAUSHAW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BEAUSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:985-502-0264
Mailing Address - Street 1:119 VILLAGE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5301
Mailing Address - Country:US
Mailing Address - Phone:985-502-0264
Mailing Address - Fax:
Practice Address - Street 1:119 VILLAGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5301
Practice Address - Country:US
Practice Address - Phone:985-502-0264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1942251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health