Provider Demographics
NPI:1952628364
Name:BEASTON, JESSICA ELIZABETH (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:BEASTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BEASTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:3208 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-7403
Mailing Address - Country:US
Mailing Address - Phone:217-430-6146
Mailing Address - Fax:
Practice Address - Street 1:3208 CORAL DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-7403
Practice Address - Country:US
Practice Address - Phone:217-430-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-24
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006621101YP2500X
IL180015191101YP2500X
IL101YS0200X
MO101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional