Provider Demographics
NPI:1326137043
Name:VCHULEK, BEVERLY DIANE (MS,MA, LMHC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANE
Last Name:VCHULEK
Suffix:
Gender:F
Credentials:MS,MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 CHIEF MATE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-9688
Mailing Address - Country:US
Mailing Address - Phone:850-637-3986
Mailing Address - Fax:850-637-1178
Practice Address - Street 1:2068 HEALTH CARE AVE
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2901
Practice Address - Country:US
Practice Address - Phone:850-791-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH00003448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765524000Medicaid
FLMH00003448OtherLICENSE NUMBER