Provider Demographics
NPI:1922093640
Name:LESYEA, BEVERLY S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:S
Last Name:LESYEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TWINING ST BLDG 760
Mailing Address - Street 2:
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-5055
Mailing Address - Fax:334-953-1900
Practice Address - Street 1:300 TWINING STREET
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112
Practice Address - Country:US
Practice Address - Phone:334-953-5143
Practice Address - Fax:334-953-1900
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0017731041C0700X
AL0974-2352C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical