Basic Information
| Provider Information | |||||||||
| NPI: | 1891301537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEASLEY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1223 ARGONNE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441212916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162626050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2525 E 22ND ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441153202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169322800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2020 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-20-44642 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.