MEDICARE: ELIZABETH BEASLEY

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	8332	TN

General Provider Information

NPI Number	:	1528719523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BEASLEY

Provider Business Mailing Address
First Line	:	200 TECH CENTER DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-2747
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	6055 SHALLOWFORD RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1688
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	12/08/2025

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Directions to “ ELIZABETH BEASLEY ” Practice Location

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