Provider Demographics
NPI:1386337566
Name:BEUS, HOLLY (LAC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BEUS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N 24TH ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1470
Mailing Address - Country:US
Mailing Address - Phone:602-326-0774
Mailing Address - Fax:602-513-7394
Practice Address - Street 1:7565 E EAGLE CREST DR STE 201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1067
Practice Address - Country:US
Practice Address - Phone:480-201-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-11908101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty