Russell Glen Beazer, M.S.
Individual provider Active NPI Marriage & Family Therapist · Gilbert, AZ
NPI 1386730992 · NPPES record last updated Apr 16, 2020
Key facts
- NPI
- 1386730992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- LMFT-10047 (AZ)
- Practice address
- 1760 E Boston St Ste 102
Gilbert, AZ 85295-6241 - Phone
- (480) 649-6499
- Fax
- (480) 207-2580
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT-10047 | AZ | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Family Works, Counseling PLLC | Marriage & Family Therapist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT-10047 | AZ | Yes |
Addresses
Primary practice location
1760 E Boston St Ste 102
Gilbert, AZ 85295-6241
Mailing address
1760 E Boston St Ste 102
Gilbert, AZ 85295-6241
Phone (480) 649-6499
Other practice location 1
1772 E Boston St
Suite 107
Gilbert, AZ 85295-6242
Phone (480) 649-6499
Other providers in Gilbert, AZ
- Cameron Beatty
- Bridget Beauchamp
- Alyssa Beauregard
- Kristina Beaver
- Michaela Beaver
- Taylor Becerra
- Anne Bechard
- Brian Beck
- Todd Beck
- Matthew W Becken
All providers in Gilbert, AZ · Marriage & Family Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.