MEDICARE: MRS. JESSICA ELIZABETH BEASTON LCPC

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	178.006621	IL
2	101YP2500X	Professional Counselor	180015191	IL
3	101YS0200X	School Counselor		IL
4	101YS0200X	School Counselor		MO

General Provider Information

NPI Number	:	1952628364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ELIZABETH BEASTON LCPC

Provider Business Mailing Address
First Line	:	3208 CORAL DR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-7403
Country	:	US
Telephone Number	:	217-430-6146
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 CORAL DR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-7403
Country	:	US
Telephone Number	:	217-430-6146
Fax Number	:

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

Provider Enumeration Date	:	04/24/2010
Last Update Date	:	05/04/2023

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