Healthcare Provider Details

I. General information

NPI: 1972812683
Provider Name (Legal Business Name): KARLA VINCENTA BESLAY LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PROSPECT AVE
CARO MI
48723-9288
US

IV. Provider business mailing address

323 N STATE ST
CARO MI
48723-1537
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-6191
  • Fax:
Mailing address:
  • Phone: 989-673-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361002306
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: