Provider Demographics
NPI:1114173598
Name:BEVER, LYNN MARIE (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:BEVER
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11088
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24062-1088
Mailing Address - Country:US
Mailing Address - Phone:540-239-0598
Mailing Address - Fax:540-961-2694
Practice Address - Street 1:1501 LARK LN
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2658
Practice Address - Country:US
Practice Address - Phone:540-239-0598
Practice Address - Fax:540-961-2694
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770714487OtherNPI LEVEL 2
VA12073Medicare PIN