Healthcare Provider Details

I. General information

NPI: 1699961094
Provider Name (Legal Business Name): COREEN M BEASLEY MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 10741
ROCKVILLE MD
20849-0741
US

IV. Provider business mailing address

PO BOX 10741
ROCKVILLE MD
20849-0741
US

V. Phone/Fax

Practice location:
  • Phone: 240-780-8199
  • Fax:
Mailing address:
  • Phone: 240-780-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107569
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128201
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM1022
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: