Provider Demographics
NPI:1720862188
Name:BEASLEY, WILLARD (BSW)
Entity type:Individual
Prefix:
First Name:WILLARD
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-5617
Mailing Address - Country:US
Mailing Address - Phone:213-557-9895
Mailing Address - Fax:
Practice Address - Street 1:3010 E VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5617
Practice Address - Country:US
Practice Address - Phone:213-557-9895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator