Provider Demographics
NPI:1104887934
Name:BEASLEY, LEANNE K (MA, LPC, CACIII)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:K
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MA, LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 30 RD
Mailing Address - Street 2:P.O. BOX 55123
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-4437
Mailing Address - Country:US
Mailing Address - Phone:970-523-5282
Mailing Address - Fax:970-523-6003
Practice Address - Street 1:524 30 RD
Practice Address - Street 2:SUITE 5B
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-4438
Practice Address - Country:US
Practice Address - Phone:970-523-5282
Practice Address - Fax:970-523-6003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6007101YA0400X
CO3112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional