Provider Demographics
NPI:1700490711
Name:BEASLEY, JAMES ALLEN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLEN
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:LLOYD
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 S LOPEZ ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6216
Mailing Address - Country:US
Mailing Address - Phone:504-612-4532
Mailing Address - Fax:
Practice Address - Street 1:200 S BROAD ST STE 205A
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6447
Practice Address - Country:US
Practice Address - Phone:504-821-7616
Practice Address - Fax:504-821-6717
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor