Provider Demographics
NPI:1619325123
Name:A FAMILY WORKS, COUNSELING PLLC
Entity Type:Organization
Organization Name:A FAMILY WORKS, COUNSELING PLLC
Other - Org Name:RUSSELL BEAZER THERAPIST LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:480-649-6499
Mailing Address - Street 1:1772 E BOSTON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6242
Mailing Address - Country:US
Mailing Address - Phone:480-649-6499
Mailing Address - Fax:480-207-2580
Practice Address - Street 1:1772 E BOSTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6242
Practice Address - Country:US
Practice Address - Phone:480-649-6499
Practice Address - Fax:480-207-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT10047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty