Provider Demographics
NPI:1407635444
Name:BEVERIDGE, THOMAS RYAN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RYAN
Last Name:BEVERIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1459
Mailing Address - Country:US
Mailing Address - Phone:805-456-1230
Mailing Address - Fax:
Practice Address - Street 1:1111 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1459
Practice Address - Country:US
Practice Address - Phone:805-456-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)