Provider Demographics
NPI:1205539715
Name:BEASLEY, TALESIA (PHD)
Entity type:Individual
Prefix:DR
First Name:TALESIA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 BELTEAU LANE
Mailing Address - Street 2:DALLAS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227
Mailing Address - Country:US
Mailing Address - Phone:214-405-7446
Mailing Address - Fax:
Practice Address - Street 1:7116 BELTEAU LANE
Practice Address - Street 2:DALLAS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-7522
Practice Address - Country:US
Practice Address - Phone:214-827-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90966101YP2500X
TX909633101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional