Provider Demographics
NPI:1255782066
Name:BEASLEY, KESHONA
Entity type:Individual
Prefix:DR
First Name:KESHONA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 KENMAR DR STE 5
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1705
Mailing Address - Country:US
Mailing Address - Phone:412-245-7811
Mailing Address - Fax:412-646-5122
Practice Address - Street 1:113 SHARP RD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1830
Practice Address - Country:US
Practice Address - Phone:412-245-7811
Practice Address - Fax:412-646-5122
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional