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NPI Code Detail

MEDICARE: CHARMAINE BEASLEY LPC

MEDICARE: CHARMAINE BEASLEY LPC
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
1101YM0800XMental Health CounselorA1602017AR
2101YM0800XMental Health CounselorP1801007AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528412269
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARMAINE BEASLEY LPC
Provider Business Mailing Address
First Line : 2504 MCCAIN BLVD STE 118
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-7624
Country : US
Telephone Number : 501-812-6655
Fax Number : 501-812-6677
Provider Business Practice Location Address
First Line : 2504 MCCAIN BLVD STE 118
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72116-7624
Country : US
Telephone Number : 501-812-6655
Fax Number : 501-812-6677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2016
Last Update Date : 03/17/2018

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1760873988 — MARVIN EADY MHPP
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NORTH LITTLE ROCK, AR
72116-7624
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1346749504 — KIMBERLY GATES APRN
Practice Location Address:
2504 MCCAIN BLVD STE 118
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Practice Fax: 501-812-6677

Directions to “ CHARMAINE BEASLEY LPC” Practice Location

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