Provider Demographics
NPI:1861767352
Name:BEASON, LAUREL ANN (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:ANN
Last Name:BEASON
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 RAILROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2727
Mailing Address - Country:US
Mailing Address - Phone:805-237-0992
Mailing Address - Fax:805-237-0993
Practice Address - Street 1:1140 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2727
Practice Address - Country:US
Practice Address - Phone:805-237-0992
Practice Address - Fax:805-237-0993
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282571041C0700X
CALCS282571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4468140Medicaid
CAGB601AMedicare PIN