Provider Demographics
NPI:1275656985
Name:SOLOMON, BEVERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26515 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1966
Mailing Address - Country:US
Mailing Address - Phone:281-419-1080
Mailing Address - Fax:281-419-0357
Practice Address - Street 1:26515 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1966
Practice Address - Country:US
Practice Address - Phone:281-419-1080
Practice Address - Fax:281-419-0357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04136101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000S38LOtherBC BS TEXAS