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General NPI Number Information
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NPI Number | 1720209307
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Entity Type | Individual
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Provider Name | BEVERLEE J GIBBS-CASSADY ED.D.
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 416 N KENDRICK ST STE 3
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1598
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Country | US
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Telephone | 928-774-7778
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Fax | 928-913-0891
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Provider Business Mailing Address
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Address Line | 416 N KENDRICK ST STE 3
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1598
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Country | US
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Telephone | 928-774-7778
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Fax | 928-913-0891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 3410
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3410
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3410
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License Number State | AZ
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