Healthcare Provider Details

I. General information

NPI: 1356592679
Provider Name (Legal Business Name): JACQUELYN FRANCIS BEEVERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S. MAIN
MT HOME AR
72653
US

IV. Provider business mailing address

1815 PLEASANT GROVE ROAD
JONESBORO AR
72404
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-1041
  • Fax: 870-425-1049
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 Number1007-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: