Provider Demographics
NPI:1184087009
Name:BEVERLY, WILLIAM (PHD,/LMFT)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BEVERLY
Suffix:
Gender:M
Credentials:PHD,/LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 E. EASTRIDGE DR.
Mailing Address - Street 2:STE A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-777-3280
Mailing Address - Fax:928-717-1660
Practice Address - Street 1:8603 E. EASTRIDGE DR.
Practice Address - Street 2:STE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-777-3280
Practice Address - Fax:928-717-1660
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist