Individual
ILISE BEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14000 S MILITARY TRL STE 204A, DELRAY BEACH, FL 33484-2654
(561) 501-5260
Mailing address
3550 QUANTUM LAKES DR, BOYNTON BEACH, FL 33426-8342
(208) 921-4419
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMT2372
FL
Other
Enumeration date
11/23/2015
Last updated
06/11/2019
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