Healthcare Provider Details

I. General information

NPI: 1568349496
Provider Name (Legal Business Name): DANIEL M BEASLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 HAMBRICK AVE APT 1
LEXINGTON KY
40508-2339
US

IV. Provider business mailing address

718 HAMBRICK AVE APT 1
LEXINGTON KY
40508-2339
US

V. Phone/Fax

Practice location:
  • Phone: 859-619-7511
  • Fax:
Mailing address:
  • Phone: 859-619-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001069
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: