Healthcare Provider Details

I. General information

NPI: 1952628364
Provider Name (Legal Business Name): JESSICA ELIZABETH BEASTON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BEASTON LCPC

II. Dates (important events)

Enumeration Date: 04/24/2010
Last Update Date: 05/04/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 CORAL DR
QUINCY IL
62301-7403
US

IV. Provider business mailing address

3208 CORAL DR
QUINCY IL
62301-7403
US

V. Phone/Fax

Practice location:
  • Phone: 217-430-6146
  • Fax:
Mailing address:
  • Phone: 217-430-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.006621
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180015191
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: