Individual
MR. GARY REX BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
199 COON RAPIDS BLVD NW, SUITE 306, COON RAPIDS, MN 55433-5831
(763) 780-1520
(763) 780-2114
Mailing address
2211 TAFT ST NE, MINNEAPOLIS, MN 55418-4129
(612) 781-0275
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2584
MN
Other
Enumeration date
10/25/2006
Last updated
07/08/2007
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