Provider Demographics
NPI:1053556456
Name:RITLAND, BEVERLY G (LCSW, MDIV)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:G
Last Name:RITLAND
Suffix:
Gender:F
Credentials:LCSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E ROSE GARDEN LN
Mailing Address - Street 2:#71155
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7700
Mailing Address - Country:US
Mailing Address - Phone:602-810-0933
Mailing Address - Fax:623-266-7030
Practice Address - Street 1:15152 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2869
Practice Address - Country:US
Practice Address - Phone:602-810-0933
Practice Address - Fax:623-266-7030
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ110871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical