Individual
AUSTIN BEAVERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QBHP
Contact information
Practice address
707 N CARDINAL DR, MOUNTAIN HOME, AR 72653-3253
(870) 425-5644
Mailing address
205 HIGH SCHOOL DR, SALEM, AR 72576-9556
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227364795
—
AR
Enumeration date
11/10/2015
Last updated
07/02/2020
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