Provider Demographics
NPI:1578397865
Name:JANET W BEASLEY, LLC
Entity type:Organization
Organization Name:JANET W BEASLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-350-1870
Mailing Address - Street 1:1020 BARBER CREEK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5983
Mailing Address - Country:US
Mailing Address - Phone:706-257-3004
Mailing Address - Fax:706-257-3001
Practice Address - Street 1:1020 BARBER CREEK DR STE 203
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5983
Practice Address - Country:US
Practice Address - Phone:706-257-3004
Practice Address - Fax:706-257-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health