Provider Demographics
NPI:1376079996
Name:EVERSOLE, BETH (LCSW AND LCDC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:EVERSOLE
Suffix:
Gender:F
Credentials:LCSW AND LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WOODWAY DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-1506
Mailing Address - Country:US
Mailing Address - Phone:832-384-9841
Mailing Address - Fax:
Practice Address - Street 1:5757 WOODWAY DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-1506
Practice Address - Country:US
Practice Address - Phone:832-384-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12447101YA0400X
TX564621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)