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General NPI Number Information
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NPI Number | 1316370547
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Entity Type | Individual
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Provider Name | JEAN B BEAUFILS MA
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Gender | Male
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 500 LANIER AVE W STE 504
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7637
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Country | US
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Telephone | 678-817-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 CHANNING DR
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City | CONYERS
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State | GA
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Zip | 30094-4164
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Country | US
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Telephone | 267-254-5643
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007339
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC007339
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License Number State | GA
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