Provider Demographics
NPI:1073631545
Name:BEVERLY HANES, LMFT APC
Entity Type:Organization
Organization Name:BEVERLY HANES, LMFT APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST-CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:951-334-3177
Mailing Address - Street 1:PO BOX 52974
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92517-3974
Mailing Address - Country:US
Mailing Address - Phone:951-334-3177
Mailing Address - Fax:909-424-0222
Practice Address - Street 1:1420 E COOLEY DR
Practice Address - Street 2:SUITE 200 S
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3981
Practice Address - Country:US
Practice Address - Phone:951-334-3177
Practice Address - Fax:909-424-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACORP 2879938106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33BGJ3OtherRIVERSIDE CO MEDICAL
CA33BGJ3OtherRIVERSIDE CO MEDICAL