Healthcare Provider Details

I. General information

NPI: 1497111728
Provider Name (Legal Business Name): DENITRA BEASLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENITRA HARRIS LPC

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 BETIN AVE
MONROE LA
71201-7257
US

IV. Provider business mailing address

6308 ESTATES DRIVE
MONROE LA
71201-7046
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1250
  • Fax: 318-388-0941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6638
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6638
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: