Provider Demographics
NPI:1457830648
Name:MONCRIEF, BEVERLY LAUREN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LAUREN
Last Name:MONCRIEF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 HIGHWAY 4 W
Mailing Address - Street 2:
Mailing Address - City:SARAH
Mailing Address - State:MS
Mailing Address - Zip Code:38665-3529
Mailing Address - Country:US
Mailing Address - Phone:662-612-4549
Mailing Address - Fax:
Practice Address - Street 1:3747 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2942
Practice Address - Country:US
Practice Address - Phone:662-612-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM74351041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool