Provider Demographics
NPI:1184882110
Name:SAILORS, BEVERLY J (LCSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:J
Last Name:SAILORS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8466
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86427-8466
Mailing Address - Country:US
Mailing Address - Phone:928-514-5227
Mailing Address - Fax:888-421-3887
Practice Address - Street 1:2585 MIRACLE MILE STE 104E
Practice Address - Street 2:SUITE 104E
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7553
Practice Address - Country:US
Practice Address - Phone:928-514-5227
Practice Address - Fax:888-421-3887
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-122991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical