Provider Demographics
NPI:1447888417
Name:BEASON, LESLIE A (RN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:BEASON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 HOMER CLAYTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976
Mailing Address - Country:US
Mailing Address - Phone:256-582-3202
Mailing Address - Fax:256-582-3216
Practice Address - Street 1:2409 HOMER CLAYTON DRIVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-582-3202
Practice Address - Fax:256-582-3216
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-147625101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor