Provider Demographics
NPI:1528700358
Name:BEAZELL PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:BEAZELL PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:571-310-0201
Mailing Address - Street 1:11260 ROGER BACON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5252
Mailing Address - Country:US
Mailing Address - Phone:571-310-0201
Mailing Address - Fax:
Practice Address - Street 1:11260 ROGER BACON DR STE 204
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5252
Practice Address - Country:US
Practice Address - Phone:571-310-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164072146OtherINDIVIDUAL NPI