Provider Demographics
NPI:1750417820
Name:BEASTON, LARA M
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:M
Last Name:BEASTON
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 1:224 CROCKER LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3115
Mailing Address - Country:US
Mailing Address - Phone:541-731-9242
Mailing Address - Fax:
Practice Address - Street 1:2222 COBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4988
Practice Address - Country:US
Practice Address - Phone:458-210-2984
Practice Address - Fax:458-210-2985
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health