Provider Demographics
NPI:1861078008
Name:REVELL, BETH ARON
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ARON
Last Name:REVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 S POWER RD STE 103-246
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3768
Mailing Address - Country:US
Mailing Address - Phone:480-581-5900
Mailing Address - Fax:480-581-5959
Practice Address - Street 1:1959 S POWER RD STE 103-246
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3768
Practice Address - Country:US
Practice Address - Phone:480-581-5900
Practice Address - Fax:480-581-5959
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-202041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty