Provider Demographics
NPI:1013255702
Name:BEATY, JEFFERY ALLEN (DHED, LMSW)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ALLEN
Last Name:BEATY
Suffix:
Gender:M
Credentials:DHED, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 STONELEA PL
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-6706
Mailing Address - Country:US
Mailing Address - Phone:502-381-9053
Mailing Address - Fax:
Practice Address - Street 1:4600 STONELEA PL
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-6706
Practice Address - Country:US
Practice Address - Phone:502-381-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4633104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker