MEDICARE: ROSE A BEVERLY MSC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1407340383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE A BEVERLY MSC

Provider Business Mailing Address
First Line	:	2001 W ORANGE GROVE RD STE 612
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1141
Country	:	US
Telephone Number	:	520-229-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 E PIMA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-5601
Country	:	US
Telephone Number	:	520-885-1738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	06/14/2018

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