Provider Demographics
NPI:1235604141
Name:BEY, MOINA M (LAC)
Entity Type:Individual
Prefix:MS
First Name:MOINA
Middle Name:M
Last Name:BEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 N CENTRAL AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2639
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:602-682-7455
Practice Address - Street 1:3033 N CENTRAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2806
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-257-8029
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20251101YP2500X
AZLAC-17507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC-17507OtherSTATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS