Provider Demographics
NPI:1003250564
Name:KING, BEVERLY ANN (LPC- S)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:LPC- S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 BAYPORT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2305
Mailing Address - Country:US
Mailing Address - Phone:210-912-9937
Mailing Address - Fax:
Practice Address - Street 1:2939 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5015
Practice Address - Country:US
Practice Address - Phone:210-503-4468
Practice Address - Fax:210-503-4470
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional