Healthcare Provider Details

I. General information

NPI: 1669884847
Provider Name (Legal Business Name): RICHARD JASON BEALS DNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 E UNIVERSITY DR STE 100 MESA
MESA AZ
85203-8170
US

IV. Provider business mailing address

1655 E UNIVERSITY DR STE 100 MESA
MESA AZ
85203-8170
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-6955
  • Fax:
Mailing address:
  • Phone: 480-969-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN144709
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5686
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: