Provider Demographics
NPI:1407860489
Name:BEAVIN, CHRISTINE ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:BEAVIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 OLIVE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2303
Mailing Address - Country:US
Mailing Address - Phone:314-206-3802
Mailing Address - Fax:314-206-3708
Practice Address - Street 1:1430 OLIVE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2303
Practice Address - Country:US
Practice Address - Phone:314-206-3802
Practice Address - Fax:314-206-3708
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040148931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical