MEDICARE: WILLIS JEROME BEASLEY MC

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	101YP2500X	Professional Counselor	LPC-21201	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	307442	OTHER	AZ	MHN

General Provider Information

NPI Number	:	1952440299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIS JEROME BEASLEY MC

Provider Business Mailing Address
First Line	:	5055 S MISSION RD
Second Line	:	4302
City	:	TUCSON
State	:	AZ
Zip	:	85746
Country	:	US
Telephone Number	:	520-314-4307
Fax Number	:

Provider Business Practice Location Address
First Line	:	5055 S MISSION RD
Second Line	:	4302
City	:	TUCSON
State	:	AZ
Zip	:	85746
Country	:	US
Telephone Number	:	520-314-0387
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	10/09/2025

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