Provider Demographics
NPI:1609471036
Name:BEESON, SHAYLA RAYNE
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:RAYNE
Last Name:BEESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 E MUIRWOOD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8807
Mailing Address - Country:US
Mailing Address - Phone:480-610-6981
Mailing Address - Fax:480-898-7419
Practice Address - Street 1:4350 E MUIRWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8807
Practice Address - Country:US
Practice Address - Phone:480-610-6981
Practice Address - Fax:480-898-7419
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician