Provider Demographics
NPI:1316370547
Name:BEAUFILS, JEAN B (MA)
Entity type:Individual
Prefix:MR
First Name:JEAN
Middle Name:B
Last Name:BEAUFILS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 CHANNING DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4164
Mailing Address - Country:US
Mailing Address - Phone:267-254-5643
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 504
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7637
Practice Address - Country:US
Practice Address - Phone:678-817-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007339101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional