Provider Demographics
NPI:1073663639
Name:MUSE, BEVERLY A (MFT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:MUSE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 MADRAS ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1378
Mailing Address - Country:US
Mailing Address - Phone:650-599-5044
Mailing Address - Fax:
Practice Address - Street 1:1315 MADRAS ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1378
Practice Address - Country:US
Practice Address - Phone:650-599-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38557106H00000X
CAMFC38557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist