Provider Demographics
NPI:1043385495
Name:FRATES MCMAHON, BEVERLY ANN (MS LMHP LADC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:FRATES MCMAHON
Suffix:
Gender:F
Credentials:MS LMHP LADC
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:FRATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS LMHP LADC
Mailing Address - Street 1:319 EAST A
Mailing Address - Street 2:SUITE B
Mailing Address - City:OGALLALA
Mailing Address - State:NE
Mailing Address - Zip Code:69153
Mailing Address - Country:US
Mailing Address - Phone:308-284-6519
Mailing Address - Fax:308-284-6513
Practice Address - Street 1:319 EAST A ST
Practice Address - Street 2:SUITE B
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153
Practice Address - Country:US
Practice Address - Phone:308-284-6519
Practice Address - Fax:308-284-6513
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE403101YA0400X
NE311101YM0800X
NE431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84150OtherBLUE CROSS BLUE SHIELD
NE082993OtherRAILROAD
NE47 0831764 26Medicaid