Provider Demographics
NPI:1518256189
Name:BEVILL, LONNY RAY SR (MFT)
Entity Type:Individual
Prefix:MR
First Name:LONNY
Middle Name:RAY
Last Name:BEVILL
Suffix:SR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3068
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0701
Mailing Address - Country:US
Mailing Address - Phone:541-905-5423
Mailing Address - Fax:
Practice Address - Street 1:2817 SANTIAM HWY SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5254
Practice Address - Country:US
Practice Address - Phone:541-905-5423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0563106H00000X
CA27681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist