Provider Demographics
NPI:1922017706
Name:BEISER, MARK A (LCPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:BEISER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 W WINDOM ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1865
Mailing Address - Country:US
Mailing Address - Phone:309-263-5565
Mailing Address - Fax:309-263-9336
Practice Address - Street 1:2001 W WILLOW KNOLLS DR STE 110
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1262
Practice Address - Country:US
Practice Address - Phone:309-692-4433
Practice Address - Fax:309-692-8115
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional