MEDICARE: MARY ALLISON BEASLEY CATES LMFT PROVISIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	168491	TN

General Provider Information

NPI Number	:	1134785447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ALLISON BEASLEY CATES LMFT PROVISIONAL

Provider Business Mailing Address
First Line	:	1565 OVERTON PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-5136
Country	:	US
Telephone Number	:	901-481-0103
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 OVERTON PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-5136
Country	:	US
Telephone Number	:	901-481-0103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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