Provider Demographics
NPI:1730906520
Name:BESSE, CHARLENE FRANCES
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:FRANCES
Last Name:BESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MAINE ST STE 13
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3950
Mailing Address - Country:US
Mailing Address - Phone:217-577-2176
Mailing Address - Fax:
Practice Address - Street 1:535 MAINE ST STE 13
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3950
Practice Address - Country:US
Practice Address - Phone:217-577-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB1102367106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician