Provider Demographics
NPI:1689997322
Name:LAWRENCE, BEVERLY A (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 E VISTA DE MONTANA
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6957
Mailing Address - Country:US
Mailing Address - Phone:480-422-7000
Mailing Address - Fax:
Practice Address - Street 1:989 S MAIN ST, STE A#431
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4602
Practice Address - Country:US
Practice Address - Phone:480-422-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-000711171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist