Provider Demographics
NPI:1588724405
Name:BEAVER, WILLIAM THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:BEAVER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 E CALLE SIN PECADO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1283
Mailing Address - Country:US
Mailing Address - Phone:520-544-7851
Mailing Address - Fax:
Practice Address - Street 1:2802 N ALVERNON WAY
Practice Address - Street 2:300
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1500
Practice Address - Country:US
Practice Address - Phone:520-795-2396
Practice Address - Fax:520-795-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ925103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical