Individual provider · NPI-1

Russell Glen Beazer, M.S.

Marriage & Family Therapist · Gilbert, AZ

NPI number1386730992
StatusActive
Last updated in NPPESApr 16, 2020

Details

NPI
1386730992
Entity type
Individual (NPI-1)
Name
Mr. Russell Glen Beazer
Credential
M.S.
Sex
Male
Sole proprietor
Yes
Enumeration date
Oct 4, 2006
Certification date
Apr 16, 2020
Last updated
Apr 16, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106H00000X Marriage & Family TherapistLMFT-10047AZYes

Practice location

1760 E Boston St Ste 102
Gilbert, AZ 85295-6241

Phone 480-649-6499 · Fax 480-207-2580

Mailing address

1760 E Boston St Ste 102
Gilbert, AZ 85295-6241

Phone 480-649-6499 · Fax 480-207-2580

Other practice locations

1772 E Boston St
Suite 107
Gilbert, AZ 85295-6242

Phone 480-649-6499 · Fax 480-207-2580

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Marriage & Family Therapist providers in Gilbert, AZ