Provider Demographics
NPI:1154717460
Name:BEAVERS, JOSH JORDAN
Entity type:Individual
Prefix:MR
First Name:JOSH
Middle Name:JORDAN
Last Name:BEAVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 E 81ST ST STE 5100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4289
Mailing Address - Country:US
Mailing Address - Phone:405-822-7635
Mailing Address - Fax:
Practice Address - Street 1:2448 E 81ST ST STE 5100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4289
Practice Address - Country:US
Practice Address - Phone:405-822-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health