Provider Demographics
NPI:1255486338
Name:FLORO, BEVERLY J (LPC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:J
Last Name:FLORO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:SIEDLECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:513 CELERY LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1045
Mailing Address - Country:US
Mailing Address - Phone:512-699-7441
Mailing Address - Fax:
Practice Address - Street 1:1714 FORT VIEW RD
Practice Address - Street 2:#106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7671
Practice Address - Country:US
Practice Address - Phone:512-699-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16218101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028332701Medicaid