Healthcare Provider Details

I. General information

NPI: 1811150907
Provider Name (Legal Business Name): LEILANI F. BEAGLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HIGHWAY 62 412 SUITE J
ASH FLAT AR
72513-9629
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD
JONESBORO AR
72401-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-994-7060
  • Fax: 870-994-7063
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2547-C
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: