Provider Demographics
NPI:1225545536
Name:DAVIS, BEVERLY SUE (MA, LPC-S)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:SUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4401
Mailing Address - Country:US
Mailing Address - Phone:407-620-7762
Mailing Address - Fax:903-872-3755
Practice Address - Street 1:1216 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4401
Practice Address - Country:US
Practice Address - Phone:407-620-7762
Practice Address - Fax:903-872-3755
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65584101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor