Provider Demographics
NPI:1124540091
Name:BEASLEY, KAHINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAHINA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 620
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4723
Mailing Address - Country:US
Mailing Address - Phone:954-399-0441
Mailing Address - Fax:855-399-0441
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 620
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4723
Practice Address - Country:US
Practice Address - Phone:954-399-0441
Practice Address - Fax:855-399-0441
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10515103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist