Provider Demographics
NPI:1093446742
Name:WORD, BEVERLY (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:WORD
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8255 MACON RD UNIT 582
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0105
Mailing Address - Country:US
Mailing Address - Phone:901-209-9455
Mailing Address - Fax:
Practice Address - Street 1:8710 MEADOW GREEN DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1602
Practice Address - Country:US
Practice Address - Phone:901-209-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4516101YP2500X
GALPC010496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional