Provider Demographics
NPI:1255135711
Name:BEAVERS, ROCKLAN (MA)
Entity type:Individual
Prefix:
First Name:ROCKLAN
Middle Name:
Last Name:BEAVERS
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 FREEMAN CIR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-5419
Mailing Address - Country:US
Mailing Address - Phone:706-573-4110
Mailing Address - Fax:
Practice Address - Street 1:5840 TN-30
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307
Practice Address - Country:US
Practice Address - Phone:706-573-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health