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General NPI Number Information
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NPI Number | 1568944163
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Entity Type | Individual
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Provider Name | MADISON GRACE BEASLEY
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Gender | Female
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 2850 LINDELL RD
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City | LAS VEGAS
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State | NV
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Zip | 89146-6815
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Country | US
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Telephone | 702-203-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 9881 LAKE AUSTIN CT
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City | LAS VEGAS
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State | NV
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Zip | 89148-4759
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Country | US
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Telephone | 702-901-2850
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 10768-M
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License Number State | NV
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