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333 W Wilcox Dr Suite 303 Sierra Vista AZ 85635-1756 | |
| (520) 378-2613 | |
| (520) 458-5124 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 333 W Wilcox Dr, Sierra Vista, Arizona |
| Authorized Official Name and Position | Willis Jerome Beasley (DIRECTOR/ COUNSELOR) |
| Authorized Official Contact | 5203782613 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
333 W Wilcox Dr Suite 303 Sierra Vista AZ 85635-1756 Ph: (520) 378-2613 | 333 W Wilcox Dr Suite 303 Sierra Vista AZ 85635-1756 Ph: (520) 378-2613 |
| NPI Number | 1134388358 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 06/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134388358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC10904 (Arizona) | Primary |
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