Healthcare Provider Details

I. General information

NPI: 1396336871
Provider Name (Legal Business Name): GINA BEYER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N 4TH AVE STE B
PHOENIX AZ
85003-1595
US

IV. Provider business mailing address

645 N 4TH AVE STE B
PHOENIX AZ
85003-1595
US

V. Phone/Fax

Practice location:
  • Phone: 480-353-9814
  • Fax:
Mailing address:
  • Phone: 480-353-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-21380
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberOTC11247
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: