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NPI Code Detail

MEDICARE: HOLLY BEUS LAC

MEDICARE: HOLLY BEUS LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLAC-11908AZ

General Provider Information

NPI Number : 1386337566
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY BEUS LAC
Provider Business Mailing Address
First Line : 2625 N 24TH ST UNIT 7
Second Line :
City : MESA
State : AZ
Zip : 85213-1470
Country : US
Telephone Number : 602-326-0774
Fax Number : 602-513-7394
Provider Business Practice Location Address
First Line : 7565 E EAGLE CREST DR STE 201
Second Line :
City : MESA
State : AZ
Zip : 85207-1067
Country : US
Telephone Number : 480-201-1427
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2023
Last Update Date : 06/01/2023

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Directions to “ HOLLY BEUS LAC” Practice Location

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