Individual
RAVEN BEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TLLP
Contact information
Practice address
705 S MAIN ST STE 280, PLYMOUTH, MI 48170-1060
(734) 454-3560
Mailing address
14111 GREENVIEW RD, DETROIT, MI 48223-2911
(734) 957-6304
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
10/20/2022
Last updated
10/20/2022
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