Provider Demographics
NPI:1407052004
Name:MCGILL, BEVERLY NANNETTE (DMIN)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:NANNETTE
Last Name:MCGILL
Suffix:
Gender:F
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 WELTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3019
Mailing Address - Country:US
Mailing Address - Phone:303-294-0972
Mailing Address - Fax:303-294-9005
Practice Address - Street 1:2843 WELTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3019
Practice Address - Country:US
Practice Address - Phone:303-294-0972
Practice Address - Fax:303-294-9005
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56104251Medicaid
CO1470-00OtherALCOHOL TREATMENT FACILIT
CO68OtherLISCENSED ADDICTION COUNS