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General NPI Number Information
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NPI Number | 1841598059
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Entity Type | Organization
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Legal Business Name | BEVERLEE GIBBS-CASSADY
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 416 N KENDRICK ST SUITE 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 SUITE 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 | OWNER
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Name | DR. BEVERLEE J GIBBS-CASSADY
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Credential | ED.D.
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Telephone | 928-774-7778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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