Provider Demographics
NPI:1225352271
Name:STUBBLEFIELD, BEVERLY JUNE (LPC, LMFT, LCDC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JUNE
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:LPC, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 MUSTANG DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8640
Mailing Address - Country:US
Mailing Address - Phone:817-481-7474
Mailing Address - Fax:817-416-0900
Practice Address - Street 1:2401 MUSTANG DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8640
Practice Address - Country:US
Practice Address - Phone:817-481-7474
Practice Address - Fax:817-416-0900
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2516101YA0400X
TX10285101YP2500X
TX2862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist