Provider Demographics
NPI:1700125382
Name:BEASLEY, JESSICA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELLE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W MORRISON ST
Mailing Address - Street 2:STE 18
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1075
Mailing Address - Country:US
Mailing Address - Phone:573-999-2604
Mailing Address - Fax:660-269-9200
Practice Address - Street 1:600 W MORRISON ST
Practice Address - Street 2:STE 18
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1075
Practice Address - Country:US
Practice Address - Phone:573-999-2604
Practice Address - Fax:660-269-9200
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional