Beacon Group Sw Inc | |
308 W Glenn Tucson AZ 85705 | |
(520) 622-4874 | |
(520) 620-6620 |
Full Name | Beacon Group Sw Inc |
---|---|
Speciality | Psychologist - Intellectual & Developmental Disabilities |
Location | 308 W Glenn, Tucson, Arizona |
Authorized Official Name and Position | Michelle Kroeger (COMPTROLLER) |
Authorized Official Contact | 5206224874 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Beacon Group Sw Inc Po Box 50544 308 W Glenn Tucson AZ 85705 Ph: (520) 622-4874 | Beacon Group Sw Inc 308 W Glenn Tucson AZ 85705 Ph: (520) 622-4874 |
NPI Number | 1104932250 |
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Provider Enumeration Date | 08/22/2006 |
Last Update Date | 01/10/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104932250 | NPI | - | NPPES |
634495 | Other | AZ | ARIZONA DEPARTMENT OF DEVELOPEMENTAL DISABILITIES |
113035 | Other | AZ | PIMA HEALTH SYSTEM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TM1800X | Psychologist - Intellectual & Developmental Disabilities | (* (Not Available)) | Primary |
103TR0400X | Psychologist - Rehabilitation | (* (Not Available)) | Secondary |
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