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General NPI Number Information
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NPI Number | 1063993129
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Entity Type | Individual
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Provider Name | UNDREA RENEE BEASLEY LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 710 VERSAILLES BLVD
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2351
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Country | US
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Telephone | 337-404-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 NOLAN TRCE
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City | LEESVILLE
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State | LA
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Zip | 71446-3838
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Country | US
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Telephone | 337-404-7731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 17758
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License Number State | LA
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