Healthcare Provider Details

I. General information

NPI: 1588030522
Provider Name (Legal Business Name): JEFFREY WAYNE BEESLEY M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 DOUGLAS BLVD STE 112
ROSEVILLE CA
95661-4239
US

IV. Provider business mailing address

6622 WILLOWLEAF DR
CITRUS HEIGHTS CA
95621-1860
US

V. Phone/Fax

Practice location:
  • Phone: 916-542-9514
  • Fax:
Mailing address:
  • Phone: 916-342-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: