Provider Demographics
NPI:1962044198
Name:BEASLEY, MARY B (MED LPC MHSP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:B
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MED LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 LITTLE MARROWBONE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015
Mailing Address - Country:US
Mailing Address - Phone:615-308-5564
Mailing Address - Fax:
Practice Address - Street 1:1080 LITTLE MARROWBONE RD
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015
Practice Address - Country:US
Practice Address - Phone:615-308-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN605103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling